WRITING: Self-Diagnosis

The discussion Paperback Writer and I had on my uuummm post got me thinking about bipolar and the various levels and diagnosis. Then I remember this paper I wrote for my Abnormal Psychology class in college. Some of it may sound all too familiar. The professor told us to write a paper on anything related to mental illness. I wrote it on myself. At the time, I was in therapy, and my therapist was having me research two conditions and decide which was more likely my diagnosis (perhaps the only truly helpful thing she did for me). The paper was written in November 2003. I got an A (100%). I even kept the works cited on it.

Self-Diagnosis

I am not enrolled in this Abnormal Psychology class because I am a psychology major or have any interest in pursuing a career in the field. I am on the other side; I am on the “couch,” being examined, diagnosed, and treated. I took this class because I recently decided to seek the assistance of a psychologist, and I wanted to educate myself on the processes and possibilities. In addition, I am a writer and a writing student, and I hope that this class can provide me with character development ideas and help me avoid ignorant stereotypes of mental disorders. But mostly, my incentives are driven by confronting my own mental illness.

I am not entirely certain of what precipitated the confrontation of my problems. It was probably a gradual build-up to a breaking point. What could be called my “disease” no doubt emerged about eight years ago, when I was twelve. I became unstable and traumatized by my parents’ abrupt and unforeseen divorce. After that, it seemed to be a rapid progression downward, peaking in my late adolescence. However, I indulged completely and lived utterly controlled by my condition until this past year. I futilely attempted to battle my self-destructive behaviors but to no avail. I was beginning to fear myself and my actions, and I was starting to worry that I was tumbling beyond control. Perhaps teetering on that edge forced me to seek help, but more embarrassingly, I might attribute my breaking point to an encounter with the Scientologists, walking down Hollywood Boulevard in Los Angeles. My roommate, at the time, and I foolishly consented to a personality test. While she passed within the “normal range,” I apparently did not. One of their representatives, or salespeople, or recruiters sat me down and reviewed my results with me, reciting all the horrible traits and flaws in my personality. It seemed to confirm that these defects were not simply figments in my mind, and they were painfully visible to the outside world. This realization, however pathetically procured, gnawed at me for weeks. I also began to have unexplained medical problems. I suffered excruciating, debilitating cramp-like pains for weeks. Although my doctors and emergency room staff thoroughly doped me up on Vicodin, no physical cause could be determined. Panic attacks appeared later and could not be attributed to heart palpitations or thyroid problems. All of these complaints were most likely somatic, and my doctor referred me to a psychologist. The compilation of these factors pushed me into the therapy room.

My diagnosis has turned out to be amazingly complicated for me in multiple ways. The technical, defining aspects have been confusing and hazy. My symptomology seems to shift through several possibilities and perch on borderlines between choices.

My traits loosely fit the DSM-IV-TR’s criteria for Borderline Personality Disorder. I make efforts to avoid real or imagined abandonment, but they are not frantic (Criterion 1) (DSM 654). I constantly fear that the people close to me will flee from me at any time, yet these suspicions are rarely expressed, so they do not alienate the people in my life. My attitudes alternate between idealization and devaluation, especially in my relationships, yet they are not in extreme black-and-white terms (Criterion 2) (DSM 654). They do not outwardly affect my relationships and mainly stay confined in my mind and thoughts. I present an identity disturbance in a fluctuating sense of self and self-image, yet this also is restricted to my mind and is seldom outwardly expressed (Criterion 3) (DSM 654). I am constantly unsure of who I am or how I see myself, but this is a battle reserved for my thoughts. I formerly indulged in impulsive, potentially destructive behaviors, including careless sex, substance abuse (mainly alcohol), and reckless driving (Criterion 4) (DSM 654). I exhibited suicidal behavior, gestures, and threats (Criterion 5) (DSM 654). My humor was darkly shrouded in suicidal references. I was referred to the counseling center in high school numerous times for fear that I was a “suicide risk.” I also frequently burned and cut myself for several years (Criterion 5) (DSM 654). This past November 11th marked my anniversary, one year since my last cut. My moods have always seemed extremely unstable and reactive (Criterion 6) (DSM 654). I often suffer chronic feelings of emptiness (Criterion 7) (DSM 654). Inappropriate anger used to flush over me, and I would have painful difficulty controlling my temper (Criterion 8) (DSM 654). And dissociative symptoms appeared in the instances of self-mutilation (Criterion 10) (DSM 654). I would be overwhelmed by a severe sense of depersonalization; I felt disrupted from myself and reality, and I would slice myself sometimes to confirm I was alive and real.

My disease seems to flit through nearly all of the criteria required for Borderline Personality Disorder. However, personality disorders can encompass characteristics that all people periodically display (Davison 409). My symptoms obviously do not meet the extremity necessary for diagnosis. My behaviors that resemble the criteria seem to be only mild versions that appeared in the flights of a depressive episode. Also, they emerged when I was around sixteen years old and dissipated substantially, although remaining present, around nineteen. This could easily be correlated to my youth and that stage in my life. Most importantly, I have long-term relationships that my disorder has not destroyed, unlike true Borderline behavior.

With Borderline eliminated, it still remains to decide between Bipolar I, Bipolar II, and Cyclothymia. I exhibit the cycles, so it has to be determined which one I fall into. For a substantial amount of time, my only state appeared to be depressed with only minute instances that could be considered manic. However, during this time, I was a severe drinker; I got completely intoxicated nearly every day. This undoubtedly suppressed my cycles, but now that my alcohol intake has been reduced, there seems to be a near balance of depressed and manic cycles.

In a manic episode, I have a decreased need for sleep, am more talkative, feel pressure to keep talking, have flights of ideas and racing thoughts, have severe distractibility, and involve myself in pleasurable activities that have high potential for painful consequences; yet, these behaviors have not been severe enough to adversely effect or impair my occupational functioning, social activities, or relationships with others, so they would be considered hypomanic (DSM 335). In these states, I feel happy or excessively irritated for no identifiable reason; I am full of energy and feel I need to be doing something, anything. I babble on endlessly about any topic that flitters across my mind. My friends and the people around me can immediately notice the change in my behavior. This would make my diagnosis Bipolar II rather than Bipolar I (DSM 359).

In a depressed episode, I experience a sustained depressed mood, feel sad and empty, have diminished interest in pleasurable or all activities, have either insomnia or hypersomnia, experience withstanding fatigue, feel worthless, fall victim to excessive guilt, display a diminished ability to concentrate or think clearly, became indecisive, and have recurrent thoughts of death; this fits the criteria of a major depressive episode (DSM 320). In these, I feel utterly weighed down by my heavy emotions. I do not wish to do anything; I only want to crawl into bed or lie on the couch. My mind is consumed by reviewing the factors that make me worthless and unmediated guilt over things that have already passed or that I had no hand in. I feel hopeless and helpless and contemplate the possibilities that death or cutting could deliver. Unlike my hypomania, I make excruciating efforts to disguise this from people around me for fear that they will abandon me, so they rarely notice without extensive emotional probing and prodding. This would classify my disorder as Bipolar II instead of Cyclothymia (DSM 362).

I do also frequently experience the “wellness state” between my cycles. In contrast to the extremes of my cycles, wellness feels like nothing. I feel apathetic, merely mild emotions, and even occasionally dead inside. I feel like an empty, careless shell after the ravenous emotions of the cycles have abandoned me. Wellness is calm and quiet, even relaxing at times, but it feels numb and dull. In hypomania and major depressive, I have vivid dreams and intense thoughts and emotions. Both are completely conducive to my creativity and writing. Depression elicits a multitude of deep ideas, and mania provides the fuel to relentlessly pursue these ideas. My freshman year of college, in a bout of depressive insomnia, I wrote an 80 page story that was inspired by my own experiences with self-mutilation, alcoholism, and depression. It just flowed so easily from my mind. I could barely hold the words in. My cycles cultivate my work and motivate me to pursue it.

So, I fit the Bipolar II diagnosis in that I have history of one or more major depressive episode, have history of one or more hypomanic episode, have had no manic or mixed episodes, that these criteria are not accounted for by Schizoaffective, Schizophreniform, Delusional, or any other unspecified psychotic disorder, and that these symptoms cause distress and sometimes impair functioning (DSM 362). I am also considered rapid cycling because these episodes occur more than four times within a year (DSM 361). I will often cycle up and down within a day. It can be very disorienting and frustrating to be completely in one cycle then have it stripped away and replaced with the other. It is hard to determine my own disposition and feelings when they appear so intense then disappear and are exchanged so quickly. It feels as if there is constantly a whirlwind within me, rearranging and destroying every thought, disposition, and emotion I could have. I am constantly gathering myself back together in the wake of revolving cycles. Yet, I do rarely present mild psychotic features. Occasionally, I experience visual hallucinations or my own voice tormenting me in my head. These were much more prevalent in my late adolescence. I cannot determine if these are precipitated by insomnia or are true psychotic features. They are extremely infrequent and very mild, but they make me question the Bipolar II choice.

Aside from the complicated, fuzzy process of diagnosis, I have had severe difficulty with the idea of a diagnosis itself. The Bipolar is evident, yet I cling to the idea of Borderline so desperately because it explains the self-mutilation I suffered completely for so long. If I am attempting to define and explain myself in these terms, I want a reason for that more than anything. It is unsettling to realize that there is no true way to confirm what I am or could be. I feel like I am clinging to a fraying, wobbling rope when I try to confide in the reliability of my diagnosis. It is flimsy and unstable in a situation that seems variable and threatening enough.

My psychologist has given me a pretty active role in my own diagnosis. I viewed this as rather unconventional when I entered into therapy. I always assumed the psychologist sat in their chair, making quiet judgments on their little pad, without revealing them to the patient until later in treatment. However, my therapist reviewed me in several sessions then presented options for my diagnosis and allowed me to explore and evaluate them. She offered Borderline Personality Disorder and Bipolar Disorder. So far, it has seemed to be more positive than negative. On the negative, I fear that the possibility of a diagnosis being placed in my head could elicit the matching behaviors. Maybe if I start thinking that I could be Bipolar, I would start imagining and attributing things to cycles that were not present; I would remember things that did not in fact happen. However, I am more convinced that it merely opened my eyes to monitor my own behavior and note possible symptoms. I have kept extensive journals my entire life that reduce the problem of memory distortion, and the symptoms I have have been observed by my psychologist and people around me as well, so it is not relying exclusively on my interpretations. Being involved in my own diagnosis has given me a sense of control in my treatment. I do not feel helpless and uninvolved; I do not feel like I am being passively observed by a stranger. It reduces my fear of misinterpretation. So far, my psychologist and I have eliminated the possibility of Borderline based on my lack of extremity, and she seems to agree that I am Bipolar II.

The real problem in all this for me is just the idea of being diagnosed. For at least eight long years, I lived utterly consumed by my disease. I felt it distinguished me from others around me; it enlightened me and added depth to my perceptions; it was an integral part of me, my personality, who I was. To extract that enamored idea from my feeble construction of self and label it as a mere disorder was extraordinarily difficult to consider and torturous to face. It feels devaluing and minimalizing to be explained and confined in tiny, little labels and words. Also, once I began to accept the concept of a diagnosis for me, I was constantly monitoring myself, attributing every behavioral tick or variation to my new neat, tidy label. It became an excuse for everything about me and voided feeling anything for emotion itself. My family does not deal well with mental illness either. One side views it as a weakness and opportunity for ridicule. The other, with its extensive history of mental disorders, is extremely sensitive to the idea. It is a quiet, hushed experience that no one speaks about, and the word “crazy” must not be uttered in any context.

With the Bipolar II diagnosis, my causality can be theorized and traced. As I mentioned, my disease first surfaced eight years ago perhaps in response to my parents’ divorce. My entire childhood yielded no indication of marital problems. Never did even a slight suspicion present itself in my small mind. The only doubts I ever entertained arose from people talking and classes at school, and my parents quickly denied the idea. I discovered that they were getting separated by reading my mother’s journal maybe a week before she moved out. This shattered my entire sense of reality. I was traumatized; my entire life and persona changed irrevocably, and I plunged into a dark depression. After the divorce, I had a very unstable, damaging relationship with my father. The man I dearly loved as a child vanished and was replaced by a hurtful, selfish stranger residing in his body. We fought constantly, and through his altered behavior and treatment of me, he convinced me that I was worthless, not good enough, that he no longer cared for me, and so very much more, whether through direct verbal abuse or implied actions. The most detrimental effect of this situation came from my desperate, sentimental clinging to him based on the relationship we had when I was younger. His side of the family disowned me twice, blaming me for the failure of my relationship with my father. Many of my close friends in high school also betrayed and abandoned me, mostly because of my disorder.

My family presents an extensive history of mental illness. Alcoholism runs deep on both sides, but my mother’s side contains the mental disorders. My great-grandmother was repeatedly hospitalized all of her adult life for Manic-Depressive Disorder, which we now call Bipolar. She was treated with electro-shock numerous times, and my mother described her as returning home dazed and no longer herself. She was later medicated in the 1970s, but never showed any true signs of recovery. My grandfather, though never diagnosed or treated, exhibits blatant symptoms of Bipolar Disorder. He went through extreme cycles of depression and mania as long as my mother could recall. His sister presents Major Depressive Disorder. My mother has an anxiety disorder. Although her therapist never told her her specific diagnosis, she went through years of therapy and is currently on Paxil. One of her brothers has also been diagnosed and medicated for depression of an unspecified sort.

To me, all the elements of this situation adhere to the diathesis-stress model. I obviously have the genetic disposition for a multitude of mental disorders – the diathesis. But none of it appeared or developed until the stress activated, molded, and perpetuated it. I do not see it as merely genes or chemicals or as simply bad life experiences. It is all a contingent interaction of numerous factors. None can be singled out or easily identified. I am the intermingling sum of all my genes and my entire life, and they cannot be separated to determine the cause of my condition.

My treatment options are greatly simplified by my complete opposition to taking medication. I do not believe that a complex problem can be solved simply by popping pills. A friend of mine went to his primary care physician, not a mental health professional, and mentioned during his physical that he was depressed with suicidal thoughts. Without a psychological evaluation or even a follow-up appointment, his doctor threw him on Paxil and let him go. The Paxil did not assist my friend at all and only gave him adverse side effects. This does not seem like real treatment to me.

My creativity and writing are also at stake. I thrive in the extremes of my cycles, and the words pour from my mind and hand. All that evaporates in wellness, so I imagine it would dissolve completely if I chemically alleviated my malady. I did not endure this disorder for years to avoid a positive result. I will not dilute my intensity and drain my writing after all that. I feel dead in wellness, so I fear that I would feel just as lifeless if I was “cured.”

My identity is also still so blended with this disorder. It is a fundamental part of me and shapes my world. I am in no way ashamed of my diagnosis or who I am. I do not view the word “crazy” as an insult. I accept this disorder as a forming force in my life and value how it has made me. It tested me; it made me stronger; it made me different; it gave me my creativity. Perhaps it is not just a disease to be remedied; it is a real part of me that I need to learn to cope with and adapt to. I need to discover how to control it, rather than allow it to dominate me so that I can live with it as a vital aspect of my life.

This puts me into therapy and into this class. Currently, I am in individual cognitive therapy. We discuss my life and confront my distorted perceptions of certain events. I have been identifying and attempting to alter my illogical, damaging thought processes that appear in depressive cycles. I have not invested in therapy that long, yet I do see a glimmer of improvement. Confronting and evaluating my disease in itself was a massive step forward. Mostly, I relish the opportunity in therapy to express myself uncensored to an impartial party. In this, I am attempting to take control of a decision and a situation that has always seemed unmanageable and overwhelming. I am beginning to learn my cycles: what they feel like, how intense they can be, how fast they can shift, and more importantly, how to react and deal with each one and their cycling. I truly have to constantly monitor myself to prevent living at their destructive whims. If I am aware and if I make an effort at control, I can establish more of a balance and adaptation within myself. My goal is to cope with my emerging symptoms and to ride my cycles so that I can live a fulfilling life. I think I can do it, and my education no doubt has helped.


Works Cited

American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders (DSM) IV-TR. Washington D.C.: American Psychiatric Association, 2000.
Davison, Gerald C., John M. Neale, Ann M. King. Abnormal Psychology (9th ed.). United
States of America: John Wiley & Sons, Inc., 2004.