Major Depressive Disorder (MDD) and Bipolar are two of the most common diagnosis that I see in patients admitted to the psychiatric hospital where I work. Ten years ago, bipolar diagnoses were few and far between. How come all of a sudden everyone is bipolar? What’s changed?
The way medicine is practiced has changed. Insurance reimbursements to the hospitals have changed.
I would guess that eighty percent of the time when a person is admitted and given a diagnosis of bipolar or major depression, they will also come up with a dirty urine. Their drug screens almost always come back positive for marijuana, cocaine, benzodiazepines, alcohol, and/or opiates. So the question that begs to be asked, yet the doctors never do, is this: Is it ethical to medicate and diagnose someone with a mental illness when evidence points to an underlying substance abuse problem? Or, is clinical depression driving the substance abuse? There is only one sure way to find out, and that is to get a clean baseline. If the person is unwilling to address their drug and alcohol abuse, how can the proper medication be prescribed? And, as in so many cases that I know of, once a person sobers up, they often don’t need medication for depression and anxiety. They learn coping skills, and once they’re no longer ingesting a depressant and are working a recovery program of some sort, the depression lifts.
We all have our perceptions about doctors and healthcare, but when you’re on the inside, if you pay attention at all, it’s hard not to notice that healthcare is nothing more than a business. In my opinion, healthcare has drastically shifted from an industry that used to be interested in health (or at least pretended that they were) to one interested solely in financial gain—at all costs.
The cost to this money grubbing mentality is that countless lives are destroyed, millions of people are misdiagnosed, and lives continue to shatter.
Back in the 60’s, my mother had four children. She was a registered nurse and was prescribed Valium by the family doctor. Valium was the most prescribed drug, and even though the pharmaceutical industry knew that Valium was highly addictive, it was the “first billion-dollar medicine,” and more prescriptions “were written for Valium than for any other drug between 1969 and 1982.” That seemingly innocent blue pill sent her on a twenty-five-year downward spiral into addiction and alcoholism. Along the way she saw numerous Psychiatrist’s, counselors, and therapists, all looking for the magic pill that would be the solution to the madness that had enveloped her life. She was diagnosed a manic depressive, and more drugs were added: Lithium, Librium, Thorazine, and more Valium. She got worse and worse and turned to drinking more alcohol.
What saved my mother was a drunken fall down a flight of steps where she broke her neck, and somewhere in all of that madness, she encountered a doctor who was in recovery and who understood that my mother was not a manic depressive, but rather an excellent, and very sick alcoholic. My mother went to rehab and never looked back. She also never took another pill other than blood pressure medicine. That diagnosis of Manic Depressive? The professionals—all of them, including a few doctors at prestigious hospitals—were one hundred percent wrong.
How is that possible? It’s possible because when you work in healthcare you see how things work, you realize there’s a fair amount of errors that happen in hospitals, and that not all of the staff are vested in favorable outcomes. Added to the human factor is that some medical staff have lives or their own that are such a mess that they really can’t be of much help to anyone else. In addition, addicts and alcoholics can be difficult patients. It’s much easier to medicate them and send them home. Add to the pot that people are people. When you consider the commerce factor and human errors—it only makes sense that we should all approach our healthcare system with a bit more skepticism.
I spent the first ten years of my nursing career on medical units and in the emergency room. The dialogue among staff and with patients is much different on medical units compared to what I hear in the mental health arena. In mental health, people are labeled. Few professionals in healthcare understand addiction. Some think because they have a degree in addiction that they’re experts, but in many cases, they have no clue because they’ve spent little time or effort learning about recovery and what it takes to recover. They also spent little time rubbing elbows with people in addiction so they don’t understand the nuances: the lying, trauma histories, manipulation, secrecy—all of those personality twists that can accompany an addicted person. It’s one thing to read about it in a book, but not all of that book knowledge translates to dealing with people. I still think the best counselors for an addict or alcoholic is someone who’s been through addiction themselves. We get it.
The tragedy of it all is that what happened to my mother fifty years ago—continues to happen today.
Doctors treat symptoms. In twenty-four years I have yet to meet but a few doctors in any hospital where I’ve worked who recommended an appropriate treatment plan and medicine regimen for an addict or alcoholic. Too many doctors are heavy handed with the psych medication. The only doctors that I’ve met who truly comprehend the nature of addiction are doctors who are in recovery themselves. The medical community is cloaked in hubris and too many doctors have closed minds when it comes to addiction. I sit in treatment team and here’s what I hear: “Who cares.” I don’t know what to do with that person. We’ve tried such and such meds so let’s try X and see what happens.” Or, they say things like “We can’t fix their life or their stupid choices. I’ll prescribe XX and if that doesn’t help, who knows.” It’s like throwing darts. Then, the conversation veers off course to something someone saw on social media like the woman caught shaving her legs in the swimming pool while kids swam around her, or new restaurants in the area, or margaritas and Bad Juan’s, (the staff loves their alcohol) or comments such as, “So, no donuts today?” And then, on to discuss the next patient.
I do recovery work with women who are bipolar. I do recovery work with women who have depression issues. I also do recovery work with women who were told they were bipolar but once they got off the booze and decided they wanted off all the medication, they had no symptoms of bipolar and most all of them stayed sober and got their lives back, especially when they opted to stay off the Seroquel.
The best way to tell if a person who abuses drugs or alcohol is really bipolar is to start with a clean baseline. Once a person is clean and sober for three to six months, do they still have bipolar symptoms and behavior? I’ve also noticed that people who are legitimately bipolar, the medication they take for their disease does make them stable and their lives do get better. For those misdiagnosed, the medication makes everything worse. They never feel good; they continue to feel depressed; recovery is a chore. They aren’t happy; over and over again they relapse, the fear never goes away, and their lives continue to deteriorate.
Too many people with complaints of depression end up on drugs such as Abilify and Seroquel, and the primary use for both medications is psychosis. Why any physician would think it’s okay to prescribe these drugs for people who aren’t having legitimate auditory or visual hallucinations is beyond my comprehension. I also see physicians prescribe these medications to the crack head or the meth head who has been on a three-day binge and is hallucinating? Of course, they’re hallucinating. When a person has not eaten anything in three days and has done nothing but consume drugs, what do they expect? Wouldn’t it make more sense to get people off the illegal street drugs and off the alcohol BEFORE slapping them with a diagnosis that will follow them for the rest of their lives, and enable them to stay sick with excuses?
I have nurse friends from all over the country and their stories mirror my own. Everyone working in healthcare knows it’s a terrible thing to medicate like doctors do, but who can do anything to change the system? This is the way it is so if you want to keep your job, be quiet, and pass the pills.
I’ve watched this go on for years and it saddens me to no end. People cannot find wellness when they ingest all those brain scrambling pills, especially when their brains may be perfectly normal other than they’re an addict or an alcoholic—and abstinence and recovery take care of that! We know that alcohol is a depressant, so how does it make any kind of sense to medicate and diagnose people with major depression if every day they ingest some alcohol?
I imagine that if I wasn’t a woman in recovery, or if I didn’t witness first-hand the complete demoralization of my mother, mostly at the hands of “professionals” and, yes, of course, she had a part when she turned to alcohol, but if it weren’t for her experience and what it did to our family, perhaps I wouldn’t be so passionate about telling you the truth. It’s a disgrace: the numerous lives and families that are destroyed because of misdiagnosis and the liberal prescribing of medications has escalated. It’s a social cancer: Paxil, Abilify, Depakote, Lithium, Seroquel, Neurontin, Effexor, Ativan, Xanax, Klonopin. These are some of the frequently prescribed medications that I see, and they seem to be the culprits behind all the serious declines. I have to ask, do people even know what they’re taking?
It’d be one thing if people got well and skipped out of the hospital, but that’s not the case. Instead, what I see more often than not, is a slow decline of the person’s life over a period of months and years until frequent hospitalizations becomes their new norm. Children suffer; people lose their jobs; they lose their motivation; they lose their self-respect, and nothing ever gets better. It’s painful to watch the medicating of people who could be helped instead by a recovery program to get them off the pills and the booze, and then decide if they need all those mind-numbing drugs. There’s a huge difference between taking an antidepressant now that you’ve been sober a few months or more and know it’s not the drugs or alcohol that keeps you in a dark space, and taking a multi-drug cocktail that the doctor prescribed while you were under the influence of drugs or alcohol— never mind the damage some of those drugs do to the liver and kidneys. Wouldn’t it make sense to consider substance abuse first, if each time the person comes to the hospital there are drugs and alcohol in their system? Of course, it would, but the hospital rarely addresses the real issue—how could they when the unspoken goal is to make money and there’s not a lot of money to be made when people recover.
If I hadn’t spent years in the mental health field I would’ve never known how inadequate and broken our system is. Mental Health in America should be renamed—medication management because that’s all the psychiatrists’ are interested in doing anyway. As one psychiatrist recently quipped, “If people don’t want medication, why do they come to us?”
People can make much better decisions when they understand the truth. The truth is this: Don’t get too attached to your doctor. They have their own lives and their own problems and they’re not all that vested in each and every patient. How could they be? Reality tells us they can’t, so with that in mind, we all can make more informed, and better decisions about our own healthcare.
Lisa is the author of the multi-award winning book, Raising the Bottom: Mindful Choices in a Drinking Culture. After short stints where she trained polo horses, worked as a flight attendant, hairdresser, and bartender, she revamped her life and settled in as a registered nurse. For past twenty-eight years has worked with hundreds of women to overcome alcoholism, live better lives and become better parents. She was prompted to write Raising the Bottom when she realized after twenty plus years of working in hospitals, that doctors and traditional healthcare offer few solutions to women with addiction issues. You can also follow her on Twitter @LBoucherAuthor and Instagram