Saturday, December 24, 2005

Part 1: Psychiatry Is Not An Exact Science

Last Sunday I checked myself into the hospital for severe depression. I did the same thing at the beginning of November (I posted about that when I began this blog.) Both times I was feeling suicidal, so I asked for help in dealing with my feelings. Back in my early 20's I thought that killing myself was the only option I had for relieving the mental, emotional, and spiritual pain I was in. I now know that suicide is not a solution, but a symptom. I learned that from a very competent therapist and also from training years ago when I worked the phone lines at a suicide and crisis center.

I was discharged last night. I tell you, the Internet withdrawal was almost as bad as the caffeine withdrawal. Because the hospital I went to treats people with alcohol and substance abuse problems, caffeine was banned as an undesirable substance. Tomcat surprised me with a thermos of coffee in the car on the way home (that's my Schmoopie!), and when I got home, I made another pot of coffee. Yes, I was bouncing off the walls last night, but I didn't care. It was the principle of the thing, damn it.

While in the hospital, it occurred to me several times that I really should make some notes or something so that later I could blog about the whole experience. Some of you may remember the slogan from my old blog, "I only write true things." Well, like most bloggers, I held back some truths about myself, like the facts that I had an abusive childhood and have been in and out of hospitals and therapy, and on medications for most of my adult life. I want this blog to include these truths, because after all, they are essential to who I am. You know, blogging is some form of self-therapy, anyway, isn't it? At least for me it is... So I want this blog to be about the real stuff. But did I keep any notes? Nooooooooo, I was too effing depressed for that. So now, I'm going to try to remember many of the things that happened and blog about them here. You might find some of it interesting, and maybe even entertaining or humorous (you know, gallows humor, as it were.)

I may end up doing this in more chronological order, but let me start with what happened late yesterday afternoon as I was about to be discharged. As you might imagine, lots of people were going home yesterday because of the holidays. In fact, early yesterday morning I overheard some of the nursing staff talking about that. It was at morning shift change, and the night shift was telling the morning shift that six people were being discharged that day.

There was a cry of dismay, "Six!?"

"But I thought it was four," another one said.

Someone else said, "Four's bad enough, but six?" At this point I thought, "Bad? What's bad about it? Won't your workload be decreased?"

But then I heard another person say, "How will we get all the paperwork done?"

Ah. The paperwork. Late yesterday afternoon, I was handed some paperwork. First were two surveys about my stay there. I had nothing but glowing things to say about this hospital. It's a different one from where I was in November. The November one wasn't bad by any means, but this second one had a much more comprehensive program and a different philosophy on how to treat patients (more about that in later posts.) Then there was a consent form allowing the hospital to give out my medical information to ... someone. The blank for the someone was ... blank. I asked the nurse whose name was supposed to go in the blank. She said it would be the name of the new psychiatrist I would be seeing as an outpatient, a doctor they had already set me up with three weeks from now. I asked her to fill in the blank with this guy's name because I didn't want to sign a blank(et) consent. Lastly, there was a form that listed all my meds and instructions for taking them. At the top of this form was my name, patient number, dates of admission and discharge, and my diagnoses. I could not believe what the hospital doctor had put for the secondary (called "Axis II") diagnosis. It was "Borderline Personality Disorder" (called "BPD"). The first Axis was what it has always been: "Major Depression, Recurrent, Severe."

BPD? How strange. All my previous records listed my secondary diagnosis as "Dissociative Disorder, NOS" ("NOS" stands for "Not Otherwise Specified"). This doctor, who had never seen me before, changed my diagnosis when I first came into the hospital. I asked him about that as soon as I found out about it, which I believe was about Day Three. Now, here it was Day Six, and what he had previously told me was only his preliminary diagnosis still stood. I completely understood that a preliminary diagnosis had to be made upon admission to the hospital, but I was surprised to see that it was still on my record at discharge. (This record would go to the new psychiatrist I'd be seeing as an outpatient). Well, it could be that he had forgotten to change it, or that he had not forgotten and just decided to change it even though other doctors over the years had made a different diagnosis. You see, psychiatry is not an exact science at all, but is subjective, that is, based on a doctor's individual perceptions. Hopefully these perceptions are compliant with the recognized diagnostic criteria used by everyone in the profession. That's of course why the criteria exist, so that everyone is on the same page, so to speak, when making diagnoses. But what if they're not in line with these criteria? Maybe that would be not so much a case of psychiatry is not an exact science, but one of not all psychiatrists are created equal.

To be continued...