On Monday, with a forty-year history of depression, I was admitted to inpatient psychiatry in a suicidal state. On Wednesday, my psychiatrist went on holiday, leaving me in the care of Dr. Jane Kou. She had not seen me in ten years, nevertheless, on Friday she wrote an order for me to go on pass after only spending ten minutes with me.
I had been diagnosed with bipolar disorder, type two, which has the highest fatality rate of any psychiatric disorder. You can’t live with the continual and progressively worsening depression. At home on pass on Saturday I attempted suicide (again). I was ambulanced to the hospital, crashed in the Emergency Room, and spent a month in the ICU on life support. In order to maintain me on life support, I was anesthetized so that my inadequate breathing struggle would not compromise the actions of the ventilator. In short, I was unconscious for a month.
In the year following, there was much sturm und drang about who had done what and why resulting in my suicide attempt. I was on inpatient psychiatry. Why did Dr. Kou write an order for me to go out on pass when I’d been admitted in a suicidal state? It was her job to keep me safe and she had failed. I wanted answers, so I filed such complaints as I was able.
My recollection is that one of my complaints necessitated me getting my hospital records. I was looking for the records from the psychiatric unit prior to my going out on pass, but the hospital also sent me the records from the intensive care unit after I came back from pass. In reading through them, I saw that the attending physician in the ICU had entered a diagnosis of paranoid schizophrenia.
I was livid! How could I be diagnosed with paranoid schizophrenia when I was unconscious? Did I just look schizophrenic? How does a person with schizophrenia look different from a person with bipolar disorder? I brought it up with my psychiatrist. He laughed and said that the attending physician had come from a state psychiatric system where everybody had paranoid schizophrenia and that must have been why he entered the diagnosis for me.
It was an entirely unacceptable answer, nevertheless, it stands. An internist makes a psychiatric diagnosis without consulting the subject specialist? Without any corroborating tests or interviews? He enters a diagnosis from habit? What kind of sloppy practice is that? And nobody questions it? And when it is finally questioned, the answer is laughter?
The diagnosis stands. There is no way to remove it from the record. I have unconscious paranoid schizophrenia.
This is how psychiatric diagnoses are made. The next time you hear that someone has been diagnosed with a psychiatric disorder, ask if the patient was conscious and what were the experience and qualifications of the diagnostician.