Saw a new shrink today. He was very good, very empathetic, very sharp, & he made his diagnosis based on my narrative history & recollections rather than on the standard bipolar checklist. This helps, since I tend to answer "no" to most of the classic bipolar trigger questions (did you ever believe you were King Henry VIII? Did you ever drop $50,000 on lawn ornaments? Did you ever try to break your way into the porn industry?).
He seemed to peg my diagnosis as bipolar not otherwise specified (NOS), that funky-ass catchall category that acknowledges you can be manic-depressive without drawing up plans to build a nuclear power plant in your backyard. This reading certainly makes sense. Like I said in an earlier post, I worry that I see manic depression where it doesn't exist. But this shrink pointed out specific symptoms that do suggest a bipolar-spectrum disorder: My depressive episodes often involve some sort of high-stress trigger (Kerry losing in 2004, for example); my mood changes tend to be seasonal, at least when they're relatively stable (OK in the summer, up a tick early in the fall, then noticeably down around January, & back up again in early spring); and my sleep patterns fit, at least at their worst (staying up later & later every night until I'm sleeping during the day, then crashing & snapping back to a pseudo-normal-human schedule).
I switched to this guy mainly because I was getting tired of the behavioral dreck I was getting from my therapist. It helped for a while, but I keep seeing cognitive behavioral therapy (CBT) as a kind of modern-day blame-the-patient approach: It's not your fault that you never learned to behave properly, but we'll fix that. As much as I appreciate the need for personal responsibility, you won't get very far telling me the reason I'm crazy is that I failed to grow up. My therapist never went so far as saying he didn't consider bipolar disorder a real disease, but he always seemed to lean in that direction -- taking medicine is a good idea, & you shouldn't stop, but our biggest concern is making sure you learn how to behave like a responsible adult. More than a little condescending, frankly -- I doubt many therapists who've actually lived with mental illness would feel that way.
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I think the behavior therapies tend to come off that way. DBT does sometimes also. I think it's just that they focus on such different things than bipolar or the physical mental health realm. It can be hugely frustrating when you're trying to deal with the brain chem/physical side of mental illness. I so know. But the behavioral drek is what the CBT types and DBT types are supposed to do. So it sounds like it's the right thing that you got a new shrink if the other isn't where you needed to be.
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