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Mental Health Matters

bipolar, bipolar disorder, Dr. Paul Markovitz  Q. The scope of my question is so wide! I know you are limited. I was fine, working out 5 days a week, 15% body fat, worked two jobs (always have) and went to college part time. After my hysterectomy, I began with horrible PMS and leg aches and extreme fatigue and pain. I was told I qualified for fibromyalgia-the 5th person in my immediate family to have this. Then in college majoring in psych, recognize I have bipolar qualities-one brother, mom and two sisters have been told this same diagnosis. I start treatment (?) for bipolar and run into a psychiatrist that takes no history from me, ignores my genetic history and tells me I have BPD and to go back to work and I will never make it to grad school and quit acting like I am suicidal when I am not. Claims I want medication and I am on it-not from her but a mental health facility for people who are poor (or their husbands don't want treatment that might cost them anything), kicks me out of her office for crying because it is counterproductive. I don't know this woman-never seen her-but she is vile to me as if I am a creature trying to get over on her. I don't understand-am I bipolar or BPD? Do I have no right to ask for help? Do I not deserve therapy? The symptoms got in the way of my life-I didn't look for them. Always been productive and busy-I am so confused and upset. Don't know who to believe or what to report or....? She said no one would work with me and I could not be helped. Please... what should I do? I don't trust psychiatrists-never met her and I have an agenda????? I want to go to grad school and have a life. Surely I can stumble on with medication. She said I didn't need any meds, but my therapist disagrees, so...After I received Depakote (1000), I am much more human. I also take Effexor (75-150) IN THE MORNING, and Trazodone (150) at night to sleep. Doing okay-just the fatigue which I think is from pressure from seeing someone to help me!!!! Why did she approach me that way? I am now more aware of my actions and how others perceive me. Never noticed before. It is like I have been in shock or a shell all my life-never matured till took stock of myself in college. A school psychologist helped me become aware. I know now medication is the best way to go, whatever it is I suffer from. And I take it whether I feel good or bad-won't stop it even when life gets gray! I have had suicidal ideation. But is it correct? Do I have a real diagnosis? I know Akistal is doing good work in the bipolar spectrum-so.... but BPD sounds awful like I am hopeless - that is what the psych said to me. She also said psychiatrists don't do talk therapy so she wouldn't let me tell her any of my family issues or treatment, but she pigeonholed me really quick anyhow. She made me so ashamed to be alive and wanting.

  A. Sorry the experience was so bad. Sounds like you got hold of a bad clinician. Clinicians, like all other professions exist along a bell shaped curve. Most are average. A handful are really good, and unfortunately, there are some really bad ones. Sounds like you had a chance meeting with the latter type.

BPD is no more hopeless than bipolar. Your brain chemistry, which is likely genetically preordained at determined at conception, is a template that allows your personality to develop along a specific path (the Danish and Minnesota adopted apart identical twin studies really do suggest a negligible contribution of environment. I strongly recommend a fine book by David B. Cohen published by John Wiley and Sons, New York, 1999 entitled Strangers in the Nest: Do Parents Really Shape Their Child's Personality, Intelligence, or Character?). There are no "right ways" to personality on the whole, albeit there are certain behaviors which are socially unacceptable. If you can avoid these behaviors, everything should be fine.

In my domain of work, most borderlines do at least as well as bipolars from a work and functioning standpoint. Many individuals have an overlap of the two disorders, and both disorders share many characteristics. Either the psych is wrong or inadvertently uninformed. There is plenty to do if you have BPD. You may want to get your Effexor up if you are still getting suicidal. Discuss it with your current psych, and refer to my article in Psychopharmacology Bulletin in early 1995.