Day Off

Wednesdays are my day off but crisis happens when it happens, so I found myself on messenger with a long ago client, H., who was really upset because her new therapist had just diagnosed her with Bipolar Disorder with psychotic features. I was puzzled by this, since I have known her for twenty or so years and never seen her manic. “How many times has she seen you?” I asked. “Two,” she said. That’s the first problem- when I was in school we were taught that you can’t diagnose bipolar until you have known someone for a while and been able to observe their moods. But since payment is based on submitting a diagnosis, that gets tossed aside and people diagnose based on whatever information they can gather right away. While I try to calm H. by explaining that all these diagnoses are really just categories made up by a bunch of doctors sitting around a table, and are more of a communication shortcut than a scientific truth, I think about what could possibly have triggered this diagnosis. “She said it was because I was mad at my kid,” H. says, and there it is – irritability is often associated with mania. You have to consider, though, where else it may be coming from. H. was abused as a child, spent years as a homeless addict, and is now homebound with heart failure, stuck in a house with her special needs four year old in a small town that doesn’t have the services either of them need. I’d say anger is a normal reaction in someone for whom life has never been fair. The conversation turns to medication. H is dubious. “They have been trying to force medication on me since age three,” she says. She thinks there’s no point in medication because it won’t fix her terrible circumstances, and she’s right, meds can’t increase her disability payments beyond bare subsistence level or provide the car she needs to get absolutely anywhere. “Medications can sometimes address the underlying layer of depression so then you just have the situational layer to deal with,” I tell her. “It’s like things that suck still suck but the fact that they suck hurts a little less deeply.” I leave her thinking that over and get back to my exciting day off routine of changing litterboxes and gathering laundry.