Q: Why 'Physical' or 'Psychiatric' Distinction for Me
I have not been diagnosed yet, but I have symptoms of Bipolar II, i.e., rapid
cycling (became ultra-rapid in July-August of 2001. I had not been on
antidepressants for some time before that time.)
My question concerns DSM criteria for bipolar. It states symptoms cannot
be attributed to any medical condition or reaction to drugs.
I was diagnosed with major depression but exhibited manic symptoms after being
on Trazadone for several months. The med was so effective for my
depression that I did not know I had a problem until I got into serious trouble
(risky behavior, spending, eventually a suicide attempt). That was six
Also, I have fibromyalgia-like symptoms and chronic fatigue to the point where I
am disabled most days. My doctor told me I probably cannot be officially
diagnosed with these disorders since I have a lengthy history of depressive
All of this is confusing to me. One doctor tells me my problems are
physical and another tells me my problems are psychiatric. Why does it
have to boil down to one or the other? Why is it so difficult for some to
accept that a person can suffer from more than one illness? I am having a
very difficult time with moods/mixed episodes and chronic fatigue and pain.
It doesn't matter to me who treats me; I just want to feel better!
I believe DSM is supposed to be only a guideline, but some doctors go strictly
by the book, and that leaves people like me out in the cold.
Dear Barbara --
Your frustration is entirely understandable, one that I've had too although from
the other side of things, i.e. the treatment side. You ask "why does
it have to come down to one or the other", physical or
"psychiatric"? Right -- as though there is really some
distinction to be made between the two. As you can probably see, the
distinction arises in part because of the training and mindset doctors get in
medical school (not to mention Rene Descartes and years of tradition following
his "mind-body dualism"). With symptoms like yours, which are
difficult to treat from any perspective, you become a "hot potato" --
no, she's your patient; no, she's your patient, etc. It wouldn't be
so tough if there was a great treatment for your symptoms -- then it would be
more obvious who was supposed to do what.
However, in my experience I've seen fibromyalgia and
fatigue and mood symptoms show up in the same patient, often not together, but
almost as though there were independent "cycles" for each set of
symptoms. And, I've seen a few of those folks do better when I set out to
treat at least their severe insomnia and their mood instability, using mood
stabilizers. Often there's a history of childhood or sexual trauma that
needs to be addressed through psychotherapy. But I have seen some clear
improvement in symptoms, even just from the medications alone.
Unfortunately it's often not the dramatic complete improvement that would allow
us all to say "see?" to the doubters, i.e. those who were saying
"no, this is not a problem I'm supposed to treat".
So on the basis of the your story here, I'd have some
hope that by treating you for "bipolar disorder", as though that were
the main problem (which means using
stabilizers and no antidepressants, basically), you might see some impact on
sleep and pain and maybe even energy as well. I hope that's what
Published November, 2002