In 1997 I was a happy person. I had recently moved to the city with my then-boyfriend, gotten a little distance from my family, and started attending university. I was feeling uplifted by the challenge. I was used to a roller-coaster of moods through my earlier teenage years, but I thought that turbulence was behind me. I had no idea anything was brewing in my brain.
Unfortunately, by the end of 1998, my mental health had reached its breaking point. I had slid, little by little, into the vortex of a severe depression. By that time I was wishing for death every day, could barely get out of bed, and had turned to self-harm for some small measure of relief. I had no idea why these things were happening to me as nothing notable had preceded them, but they were obviously happening — brutally. One night I decided to face my fears and research what was happening to me. I searched website after website and, of course, ran into the definition of major depression everywhere. But then, on one of the sites, I ran into the definition of bipolar disorder. While I knew I was in a severe depression now, I also knew that in I had experienced times that seemed an awful lot like hypomania. By the time I had printed off a tree’s worth of information about the condition and cried a tissue box worth of tears, I suspected that I knew what was wrong with me — I had bipolar disorder.
When I got in front of a psychiatrist, I told him I had bipolar disorder and why I thought so. But the doctor disagreed. Even though I was severely suicidal, self-harming, and could barely function, he diagnosed me with “minor depression.” When he said those words, I felt very strongly that he was wrong. But I didn’t have the confidence to stand up for myself because I was so depressed. I was intimidated by the doctor and his years of experience. So when he said “minor depression,” I said, “OK.” He treated me with antidepressants that — not surprisingly — didn’t work. In the back of my mind, I knew he was treating me for the wrong disorder. Not only did I know there was nothing “minor” about my depression, I also knew I had bipolar disorder. Hypomania is different for everyone. One person’s hypomania might be close to another person’s normal. For this reason it’s critical, as a patient, to evaluate your own mood carefully. You are the only one who will be able to detect a mood that is “higher” than your normal because you’re the only one who knows what your normal is.
Sometimes it is difficult for a third party to detect hypomania. Who knows whether your energy level is “too high?” You do. Who knows if you’re talking more than normal, faster than normal? You do. Who knows if your behavior is abnormal for you? You do. For me it was all obvious. I could remember distinct times, going back to my childhood, where I was just too high. I could remember talking so much and so fast that others didn’t understand what I was saying and told me to slow down. I could remember times when I felt incredibly brilliant and “greater” than everyone else. All these were clear signs of hypomania, but they were not clear enough to my psychiatrist.
In the end, I felt he didn’t ask the right questions to get to the bottom of either my severe depression or the presence of hypomania. (Although, to be fair, bipolar disorder was not his specialty and back in 1998, bipolar type II — which contains the presence of hypomania — was not so readily screened for.) Eventually I got lucky. My doctor went on holiday and I had to see someone else. This new doctor listened to me when I said I had bipolar disorder and started to treat me for it. I don’t know what would have happened if that particular doctor hadn’t walked into my life, but I suspect it would have been years of incorrect treatment and ill health. Nonetheless, getting this correct diagnosis didn’t magically make me better. It still took more than a year to find a medication that worked for me. But sure enough, it was a medication for bipolar disorder, and not one for major depression, that worked. If I had not received the right diagnosis, I could not have started that long process.
What I learned is that while psychiatrists know a tremendous amount about the brain and mental illness, they can’t see inside your brain and your mental illness. Certainly, diagnosing yourself is dangerous and would lead to a high rate of failure due to lack of medical training, experience, and knowledge. But it’s important to make sure your doctor listens to you and you feel good about their understanding of the symptoms you’re describing when making their assessment. The mistake I made was being far too timid to express what I thought and why. I waited for him to ask the right questions instead of me presenting what I had experienced. This was not my fault. In a perfect world, we both would have done a better job.
If you feel like you have the wrong diagnosis, you need to get a second opinion and a second complete assessment. I was lucky that the second doctor didn’t rubber stamp the first diagnosis – which can often happen – so you may have to fight for a thorough second assessment. Fighting to get yourself heard is crucial. Without that key, correct diagnosis, your chances of finding an effective treatment are much slimmer. Stand up for yourself. Advocate for yourself. Psychiatrists can only help you once they understand the problems you’re facing. For a second opinion, consider working with a therapist as well.