Bipolar Disorder

Every once in a while I get to use the 23 years of education I obtained. Following is evidence that, indeed, I am actually a doctor.

While on internship and post-doc I found myself being confused by the requirement to "assign a diagnosis" to whomever walked through my door for help. To assign a diagnosis is indeed important as it guides treatment planning and implementation, and gives outside clinicians a brief idea of what behaviors/issues the clients are presenting with. However, I believe - much to the disappointment of some of my supervisors during those years - that in order to be a good diagnostician you need to get to know the diagnostic criteria (obvious) as well as the person/family sitting in front of you. Diagnosing from the hip went against my grain and left me feeling quite uncertain...as if I had incorrectly labeled someone. Which is important...once you give a diagnosis to someone, that diagnosis has the potential to become a label by which to identify that person and sticks with them until the end of time. This can be gravely dangerous, especially when working with children in the school system. The schools LOVE to have diagnoses, and once the teachers hear "ADHD" or "Conduct Disorder" that poor child doesn't have a chance in hell. Regardless of what we all think of the teachers who watch over our babies during the day, they are human and they have biases and sit in judgement.

Now, on the other hand, diagnoses WHEN USED CORRECTLY can be quite helpful in guiding treatment. Yet, I am often struck by colleagues and other mental health professionals who go with the diagnosis du jour without doing proper and thorough investigation. 10 years ago it was ADHD for children, and now it has become Bipolar Disorder. This is a serious illness, folks. And very complicated. Wouldn't want my kid to have it. And there are some children who do indeed exhibit symptoms associated with Bipolar Disorder, which can make their lives and their family lives hell. Here is a recent NIMH article that touches on the seriousness of diagnosing children with Bipolar Disorder.

Having said all of this:

1. If you find you or a family member needs mental health assistance, do your homework and find a clinician that looks at the behaviors and symptoms over time and in different settings (home, school, playground, work, etc.).

2. The best clinician is one that is a good fit for you, in addition to #1. This means it may take seeing and talking to 2 or 3 clinicians to find the right one. Treatment will fail if you don't like your treatment provider.

3. If you hear the diagnosis du jour, be skeptical. Do your homework. Get second and third opinions.

4. The clinician should focus on the behaviors and symptoms, not the diagnosis. If they focus on the diagnosis...RUN.

5. Treatment should be a collaboration between you and the clinician...this is important.

6. Finally, know that a diagnosis is just a label that contains in it's definition a description of the symptoms and behaviors that are included in the label. Focus on the symptoms and behaviors...your clinician will, too.