Searching Within

Tag: depression

  • Getting Me Right

    In December, I raised two errors in my medical records. The After Visit Summary said I was a year younger than I was. And my diagnosis was listed as bipolar 1 instead of bipolar 2.

    Different flavors of the same underlying issue: being documented incorrectly. But not equally serious.

    The Diagnosis Piece

    Bipolar 1 and bipolar 2 are not typo-adjacent. They are clinically distinct conditions.

    My layperson understanding of Bipolar 1 includes things like: thinking you’re God, hallucinating, ending up on a rooftop thinking you can fly. The Richard Gere movie Mr. Jones captures the picture pretty well. Bipolar 1 involves full manic episodes, sometimes with psychosis, sometimes requiring hospitalization.

    I have never had any of those experiences. As a person (not a medical professional), I know I am not Bipolar 1.

    Bipolar 2 lives in hypomania and depression. When I am hypomanic, I recognize the pattern. High energy underneath everything. Talking fast. High creativity. Sleeping very little. Overspending. Promiscuity. Changes in appetite. Less severe than full mania. Hypo, as in less than. I don’t lose contact with reality. But it’s still bipolar. And the depressive episodes carry their own weight.

    The treatment approaches for the two overlap but are not identical. Some antidepressants that a bipolar 2 patient tolerates could trigger mania in a bipolar 1 patient. Providers need to know which one they are managing.

    I am bipolar 2. That has always been my diagnosis.

    How the Error Got There

    At some point in my history of medical records, someone changed the diagnosis from bipolar 2 to bipolar 1. A typo, a misclick, a moment of distraction. I don’t know who or when. I could probably trace it back through old summaries, but that part doesn’t matter.

    What matters is that the change wasn’t my current provider. He inherited the error from whichever chart he received. His template then pulled the wrong diagnosis forward, session after session, without anyone noticing. That’s the thing about template systems: they don’t verify. They repeat.

    Tim didn’t introduce the error. Tim is the one who corrected it once I raised the flag.

    What It Feels Like to Be Documented Incorrectly

    For months, when I looked at my AVS after each session, I saw a version of me that wasn’t me. Wrong age. Wrong diagnosis. A quiet, ongoing misrepresentation.

    Not the kind of thing you can complain loudly about. It’s paperwork. It’s a template pull. It’s not personal.

    Except it is personal. Because the record is the thing that follows me forward. The record is what other clinicians see when they look up my chart. The record is the version of me that persists past the hour we spent together in the office.

    Being documented incorrectly, session after session, is a form of quiet erasure. Not intentional. But real.

    The Correction and What It Meant

    The diagnosis eventually got fixed. That mattered.

    Tim took an extra step to ask me to send a screenshot, in order to know exactly what I was seeing. It mattered not because Tim clicked a button. Everyone with template-editing access can click a button. It mattered because Tim paid attention to the raised flag, went in, remembered to look, made the change.

    The correction was a small act of being heard.

    What Attention Looks Like

    I think this is part of why the birthday email I sent was so pointed about the AVS template

    It isn’t really about the age. It’s about whether the person documenting me is paying enough attention to keep the record aligned with the actual person.

    Corrections require noticing. Noticing requires attention. Attention is what tells me I’m being tended to, not just processed.

    Six months to update a diagnosis is a lot of processing. A little bit of tending would have gotten it done faster.

    That’s the ask.

  • Getting Your Way

    Getting your way, getting what you want, having things work out, having things go your way — are all — basically the same circumstances — that can temporarily defeat depression.

    Suddenly get an idea, a want—Then run through all the logistics to implement the idea; the pros the cons; each time the solution lands close to what you want to happen, the excitement builds; but the list of cons won’t stop re-appearing and wanting attention. The spiraling begins, wishy-washy, torture. Unable to calm the storm. What ever pleasure gained from the original idea is lost in the stampede.

    Deflating things — causing any previous decision to be questioned

    • second guessing
    • not knowing the rules
    • low self confidence.

  • Treatment Summary

    Seven steps to treatment. A bit of my history.

    In my lifetime, I’ve lived in 33 houses across 3 states. My childhood was chaotic: constant moving within Northern California (5 towns clustered around Sacramento), Oregon (3 cities), and eventually Wisconsin (2 cities). I was raised by a dysfunctional single mother. I showed goats and horses in 4-H, went to farrier school at 19, and made it through college at OSU and UW-Madison. I’ve been married twice, raised a son, worked various jobs, and have been dealing with bipolar disorder since my early 20s. First diagnosed with depression at 20, later diagnosed bipolar.

    Ongoing struggles include: chronic low self-esteem and self-doubt, overeating, suicidal ideation, and an existential question that haunts me – “Why? Why does any of it matter?” This fundamental questioning of meaning affects everything.

    One pattern that’s been consistent throughout my life: I experience intense, prolonged romantic obsessions (limerence) where I fixate on unavailable or inappropriate people. This has shaped many of my relationship choices and contributed to significant emotional pain.

    I am organizing my journal which includes the details about my unstable childhood, the moves, the dysfunction, and how it all connects to my mental health and relationship patterns.
    Receiving treatment took seven steps, over ten years.

    One

    Age 17, 1981. Senior in high school, Silverton Oregon

    Situation: I was having constant feelings of loneliness and dissatisfaction with life; I didn’t know how to describe my domineering and controlling mother and how that made me feel; since I wasn’t being physically abused at the moment, bringing up childhood abuse didn’t seem relevant. I didn’t have the words to communicate serious depression and suicidal ideation. During a break one day between classes I initiated a conversation with my Senior AP English teacher. I perhaps described to him my feeling unhappy and lonely and wishing I had stronger relationships with my friends and I wanted to know how to find a boyfriend. He then describes how life is like a cake. He said that it is important to learn to like yourself… that in life having friends isn’t guaranteed. Friends are the icing on the cake.

    Take Away

    I had been struggling with depression my whole life (age 10 onward). I didn’t know what was involved in learning to like myself. It felt like an impossible task and I didn’t have any idea how to magically start liking myself.

    Two

    Age 19, 1983. Sophomore at Oregon State University

    Situation: I was having constant feelings of loneliness and dissatisfaction with life; I didn’t know how to describe my domineering and controlling mother and how that made me feel; since I wasn’t being physically abused at the moment, bringing up childhood abuse didn’t seem relevant. I didn’t have the words to describe serious depression and suicidal ideation. In a discussion with a friend, I broached the topic of my loneliness and dissatisfaction. I adequately said something that prompted Simon to suggest I go to the Campus Health Center, as they may be better able to help than he. I went. To an older white man, I repeated the description of feelings of unhappiness and loneliness and wishing I had stronger relationships with my friends and wanting to know how to find a boyfriend. I mentioned that I was feeling a combination of spoken messages (from my mom) and unspoken expectations (from society) to be more feminine. I liked my jeans and sneakers. I didn’t want to wear lacy, flower print dresses with high heels or sandals. I worried that I would not be able to attract a boyfriend. The man said, “Well maybe you should wear a dress.” I left quickly. Didn’t go back.
    Take away: the pressures I was feeling that I needed to change who I was had been confirmed by someone new; yet, my gut reaction was that something was very wrong; and that talking about dresses completely derailed the importance of discussing issues with loneliness and dissatisfaction and building friendships.

    Three

    Age 20, 1984. Junior at UW-Madison. Living at home with my mom and brother.

    Situation: I was having constant feelings of loneliness and dissatisfaction with life; I didn’t know how to describe my domineering and controlling mother and how that made me feel; since I wasn’t being physically abused at the moment, bringing up childhood abuse didn’t seem relevant. I didn’t have the words to describe serious depression and suicidal ideation. I felt confused because I had an awesome boyfriend and I was a member of a great church with a supportive pastor; happiness eluded me. In a conversation with Pastor Tom, he recommended that I seek help from a mental health provider. I did. After a long interview with the doctor he said I had depression. He wanted to give me a prescription for depression. I said I can’t and I left. Filling a prescription would mean telling my mother. She did not believe in mental health issues. Additionally, my years of hearing messages at school about don’t do drugs was interfering with logically knowing there is a difference between drugs and prescriptions.

    Take away

    My family beliefs, my understanding of my needs, and the reality of my condition were in conflict and I didn’t know how to fix it.

    Four

    Age 25, December 1987. Married. Recently purchase 20 acre farm in Mount Horeb, Wisconsin

    Situation: Struggling with all the normal issues of life: newly married, husband working long hours at new job, purchased property that needs managing, owned horse and goats, new puppy, few months into new job, recent past job had near miss affair with supervisor. Someone I was comfortable talking to recommended that I seek help from a mental health provider. I did. After a long interview with the doctor he said I had depression. He wanted to give me a prescription for depression. As he handed me the script, he said, “I need you to promise me you won’t go home and take the whole bottle.” Fast forward to later that day… I’m home alone on the farm with just me and the animals. I can’t stop thinking that taking the whole bottle would be a bad thing. I was crying. Agitated. Scared. Fast forward to days or weeks later: I’m not remembering how long I took the medication, but the “need to give it six weeks to work” didn’t work. I gave up following the prescription. I don’t remember the details why. It didn’t help that my husband’s family, nor mine, didn’t believe in mental health.

    Take Away

    1. suggestion is a powerful thing
    2. the cure is worse than the disease

    Five

    Age 26, Winter 1989. Separated. Mount Horeb, Wisconsin

    Situation: Walked out of my marriage a couple of months prior. New apartment. Navigating a new job. Seeking comfort in sexual relations. Battling shame, guilt. Constant dissatisfaction and unrest. A counselor recommended that I seek help from a mental health provider. I did. After a long interview with the doctor he said I had depression. This time I tried harder to stick with it. I stuck with it so well, I had a severe hypomanic episode. Consult doctor about the reaction = New diagnosis: Bipolar II.

    Six

    Age 27, August 1989. Mount Horeb, Wisconsin

    Situation: Unplanned pregnancy. Stopped Bipolar medication.

    Seven

    Age 30, Summer 1993. Mount Horeb, Wisconsin

    Situation: struggling with new marriage, young child, lack of job satisfaction; sought new therapist and new psychiatrist and began work. This was the start of the next 30 years of a variety of counselors, therapists, group therapy, and psychiatrists and various treatments.