Alas, we are very good at simultaneously over and under-daignosing. Doesn't surprise me at all that a stone-cold case of Bipolar disorder went unrecognized. Very sorry that happened to you, Heather.
Police carted me to ED 5x in 6 days, the first 4 times they bounced me out, the ED psychiatrist (psychiatrist!) literally wrote in my notes "she doesn't have a psychiatric illness, police think she's psychotic, they need to be told she's not, her issues are purely behavioural"... 5th time, it's now the weekend and the relieving psych decides he can't rule out psychosis so admits me; a month in a locked ward, restraints, forced medication, seclusion etc later, 3 forensic psychiatrist reports all agreed florid manic psychosis/manic delirium for the entire week the ED psychiatry team was adamant I didn't have a psychiatric illness... and that was the very ED psych team I was given as my psychiatry placement as a med student (a decade later). (Fortunately for me, I was very good friends with a General Medicine Professor and his wife, who kept in close contact with the police that week and encouraged them to continually re-present me to ED, - everyone except mental health services knew I was a raving lunatic.)
I'd literally not lain down in 4 nights, let alone slept for four nights... but do you think ED asked about my sleep? Because the founding professor at the hospital had given me a BPD diagnosis (I was psychotic when he interviewed me, but hey...) so they just followed the management plan...
The often overlooked aspect of mental illness (or lack thereof but called mental illness) is the impact on those of us in close familial relationships with the afflicted.
It devastates families, spouses and children. So whatever the problem is, the suffering is amplified many, many fold.
I don't know the solution, but I do know the darkness it creates.
Excellent review. If I had a dollar every time I saw a patient discharged from the hospital with a bipolar diagnosis, I could build a rival spa to yours.
I’m sorry you’re in pain, but that has nothing to do with my comment. It is a reference to the general nature of hospitals jumping the gun with a bipolar diagnosis without taking a full history or even ordering a tox screen.
Often when I sit down with someone and do a full investigation, they have something else. This is incredibly important for treatment because it can open a wider range of options. For example, if I rule out bipolar disorder, then maybe I can prescribe SSRIs without risking a manic switch.
Hope you have a better day and not everything is rage bait.
Ah yes. There's always something else to label people with, isnt there? Always another drug to shove into them, isn't there? There's always a way to brush your mistakes onto them as a personality problem.
By my calculation, there are over 6,000 different combinations of symptoms that could all be counted as "bipolar" under the DSM. Ask yourself, does that make sense?
I really enjoyed this review. The "borderline" between the mental illness we diagnose and the same person's personality style and character is often nigh invisible. It doesn't help that we medical types, including the psychiatrists, dive in for pat certainties quickly. It's hard to fault someone for feeling that the diagnoses became a set of shackles at some point, and I like how your review credits Laura Delano for her work, her improvement, without taking every one of her conclusions as guiding to us in all instances. Thanks so much for writing such a clear and refreshing review.
I'm happy that this memoir is gaining attention because it is causing the general public to kick the tires of psych diagnosis, so to speak. Your review and others like it (I'm thinking of Awais Aftab's in particular) show us that the car basically holds together when the tires are kicked, but that tire kicking is a worthwhile activity.
I find it interesting, though, how quick so many psychiatrist readers of this book are to say "yep, she seems borderline". I mean, sure, probably. To be clear, I haven't read the book yet, and I probably won't. My interest in the book is mostly to do with psychiatrists' reactions to it, and their eagerness to see BPD. "The nebulously unstable woman with the long psychiatric history has the nebulously unstable woman disease," they seem to be saying. If BPD wasn't a satisfactory explanation/container/lens to Delano for her own distress, then what hermeneutical work is this construct doing? Why are so many psychiatrists so quick to cling to it with regard to Delano? Even if, historically, she fit the diagnostic criteria perfectly, she is doing a lot better now, well enough to be founding initiatives and writing books and have a marriage and a family. Why cling to BPD to describe her? (I am asking this rhetorically, in case it isn't clear.)
They do it because they know that it is a permanent mark. By repeatedly calling her "borderline," this person can wipe away anything she doesn't like with rolled eyes.
The diagnosis of Borderline Personality Disorder is per se invalid and constitutes systemic violence. It is logically impossible as it creates an unfalsifiable trap where any response - acceptance, denial, silence, or even death - is interpreted as confirming the diagnosis. It serves no valid medical purpose, as a "personality" is by definition enduring and symptoms "pervasive," making the construct internally contradictory.
The diagnosis functions as institutional gaslighting, delivering a moral condemnation while providers deny they are condemning. It is used by "experts" to permanently discredit "difficult" patients, following them through the healthcare system and prejudicing all future care. Any attempt to challenge the diagnosis, including legal action, is preemptively invalidated by the diagnosis itself, as resistance is labeled "typical borderline behavior."
Most critically, people are dying because of this diagnosis - not from any underlying condition, but because the diagnosis itself creates an inescapable psychological prison that can make death feel like the only response to having one's fundamental humanity denied. Providers know this. *You* know it. You and other providers know because patients tell you--calmly explaining, crying, sobbing, ranting, raging, dying. You know it and you cannot deny it.
The system knows this occurs. *You* know this occurs. Yet the system continues to use the diagnosis while protecting providers from liability.
BPD diagnosis is per se malpractice, fraud, and tort, constituting intentional infliction of emotional distress. It is a crime against humanity that can never be valid in any context.
From what I understand, Delano was distressed prior to meeting psychiatry - that goes without saying - but I certainly agree we deserve the lifetime of scorn she'll target the profession with; for her "inappropriate" care (as she tells it). I think our standard approach to BPD patients is inadequate at best, and until we respond to people in distress with care and kindness, as distressed fellow travellers (following Yalom) rather than "psych patients" (which I'd reserve for the manic/psychotic illnesses almost exclusively) we can expect completely justified diatribes like hers. It's not a nuanced exploration of psychiatric illness, but I'll grant that most of us find it hard to move much beyond our lived experience. In short she's limited by her own experience, but it's very hard to see further than that.
I'll add that in one of the patients entrapped in psychiatry's myth... my story is almost the opposite from hers, severe BP1 misdiagnosed as BPD and treated (if at all) with therapy for years, finally got NGRI, the bipolar diagnosis, meds... and haven't had a severe episode since, it's been years and years since I've had a mood episode and now I'm in medicine as a profession. Psychiatry is crucial to my life being worth living; without modern psychiatry (done excellently) I'd want euthenasia - my life would not be worth living. Been there done that.
I have been following the work of Drs Chris Palmer & Georgia Ede, Dr. Iain Campbell at Edinburgh, the Metabolic Mind site and YT channel, and the research getting funding from Baszucki Group with great interest. From what I can tell, ketogenic therapies are going to revolutionize the field of mental health in the coming years.
Alas, we are very good at simultaneously over and under-daignosing. Doesn't surprise me at all that a stone-cold case of Bipolar disorder went unrecognized. Very sorry that happened to you, Heather.
Police carted me to ED 5x in 6 days, the first 4 times they bounced me out, the ED psychiatrist (psychiatrist!) literally wrote in my notes "she doesn't have a psychiatric illness, police think she's psychotic, they need to be told she's not, her issues are purely behavioural"... 5th time, it's now the weekend and the relieving psych decides he can't rule out psychosis so admits me; a month in a locked ward, restraints, forced medication, seclusion etc later, 3 forensic psychiatrist reports all agreed florid manic psychosis/manic delirium for the entire week the ED psychiatry team was adamant I didn't have a psychiatric illness... and that was the very ED psych team I was given as my psychiatry placement as a med student (a decade later). (Fortunately for me, I was very good friends with a General Medicine Professor and his wife, who kept in close contact with the police that week and encouraged them to continually re-present me to ED, - everyone except mental health services knew I was a raving lunatic.)
I'd literally not lain down in 4 nights, let alone slept for four nights... but do you think ED asked about my sleep? Because the founding professor at the hospital had given me a BPD diagnosis (I was psychotic when he interviewed me, but hey...) so they just followed the management plan...
There are never too many spas!
The often overlooked aspect of mental illness (or lack thereof but called mental illness) is the impact on those of us in close familial relationships with the afflicted.
It devastates families, spouses and children. So whatever the problem is, the suffering is amplified many, many fold.
I don't know the solution, but I do know the darkness it creates.
Excellent review. If I had a dollar every time I saw a patient discharged from the hospital with a bipolar diagnosis, I could build a rival spa to yours.
Ok mate. Have a good one
Hilarious! Mocking people in distress is a great look.
I’m sorry you’re in pain, but that has nothing to do with my comment. It is a reference to the general nature of hospitals jumping the gun with a bipolar diagnosis without taking a full history or even ordering a tox screen.
Often when I sit down with someone and do a full investigation, they have something else. This is incredibly important for treatment because it can open a wider range of options. For example, if I rule out bipolar disorder, then maybe I can prescribe SSRIs without risking a manic switch.
Hope you have a better day and not everything is rage bait.
Ah yes. There's always something else to label people with, isnt there? Always another drug to shove into them, isn't there? There's always a way to brush your mistakes onto them as a personality problem.
By my calculation, there are over 6,000 different combinations of symptoms that could all be counted as "bipolar" under the DSM. Ask yourself, does that make sense?
I really enjoyed this review. The "borderline" between the mental illness we diagnose and the same person's personality style and character is often nigh invisible. It doesn't help that we medical types, including the psychiatrists, dive in for pat certainties quickly. It's hard to fault someone for feeling that the diagnoses became a set of shackles at some point, and I like how your review credits Laura Delano for her work, her improvement, without taking every one of her conclusions as guiding to us in all instances. Thanks so much for writing such a clear and refreshing review.
A very good review.
I'm happy that this memoir is gaining attention because it is causing the general public to kick the tires of psych diagnosis, so to speak. Your review and others like it (I'm thinking of Awais Aftab's in particular) show us that the car basically holds together when the tires are kicked, but that tire kicking is a worthwhile activity.
I find it interesting, though, how quick so many psychiatrist readers of this book are to say "yep, she seems borderline". I mean, sure, probably. To be clear, I haven't read the book yet, and I probably won't. My interest in the book is mostly to do with psychiatrists' reactions to it, and their eagerness to see BPD. "The nebulously unstable woman with the long psychiatric history has the nebulously unstable woman disease," they seem to be saying. If BPD wasn't a satisfactory explanation/container/lens to Delano for her own distress, then what hermeneutical work is this construct doing? Why are so many psychiatrists so quick to cling to it with regard to Delano? Even if, historically, she fit the diagnostic criteria perfectly, she is doing a lot better now, well enough to be founding initiatives and writing books and have a marriage and a family. Why cling to BPD to describe her? (I am asking this rhetorically, in case it isn't clear.)
Thanks for the thoughtful review.
They do it because they know that it is a permanent mark. By repeatedly calling her "borderline," this person can wipe away anything she doesn't like with rolled eyes.
Well nuanced review. Sometimes we get stuck in a dualistic model of care. Psychiatry is both an art and a science
It is neither. It is a pseudscience.
The diagnosis of Borderline Personality Disorder is per se invalid and constitutes systemic violence. It is logically impossible as it creates an unfalsifiable trap where any response - acceptance, denial, silence, or even death - is interpreted as confirming the diagnosis. It serves no valid medical purpose, as a "personality" is by definition enduring and symptoms "pervasive," making the construct internally contradictory.
The diagnosis functions as institutional gaslighting, delivering a moral condemnation while providers deny they are condemning. It is used by "experts" to permanently discredit "difficult" patients, following them through the healthcare system and prejudicing all future care. Any attempt to challenge the diagnosis, including legal action, is preemptively invalidated by the diagnosis itself, as resistance is labeled "typical borderline behavior."
Most critically, people are dying because of this diagnosis - not from any underlying condition, but because the diagnosis itself creates an inescapable psychological prison that can make death feel like the only response to having one's fundamental humanity denied. Providers know this. *You* know it. You and other providers know because patients tell you--calmly explaining, crying, sobbing, ranting, raging, dying. You know it and you cannot deny it.
The system knows this occurs. *You* know this occurs. Yet the system continues to use the diagnosis while protecting providers from liability.
BPD diagnosis is per se malpractice, fraud, and tort, constituting intentional infliction of emotional distress. It is a crime against humanity that can never be valid in any context.
Great review!
It's so much more complicated than Delano's view, or the one I always hear, "it's the American health care system."
From what I understand, Delano was distressed prior to meeting psychiatry - that goes without saying - but I certainly agree we deserve the lifetime of scorn she'll target the profession with; for her "inappropriate" care (as she tells it). I think our standard approach to BPD patients is inadequate at best, and until we respond to people in distress with care and kindness, as distressed fellow travellers (following Yalom) rather than "psych patients" (which I'd reserve for the manic/psychotic illnesses almost exclusively) we can expect completely justified diatribes like hers. It's not a nuanced exploration of psychiatric illness, but I'll grant that most of us find it hard to move much beyond our lived experience. In short she's limited by her own experience, but it's very hard to see further than that.
I'll add that in one of the patients entrapped in psychiatry's myth... my story is almost the opposite from hers, severe BP1 misdiagnosed as BPD and treated (if at all) with therapy for years, finally got NGRI, the bipolar diagnosis, meds... and haven't had a severe episode since, it's been years and years since I've had a mood episode and now I'm in medicine as a profession. Psychiatry is crucial to my life being worth living; without modern psychiatry (done excellently) I'd want euthenasia - my life would not be worth living. Been there done that.
I have been following the work of Drs Chris Palmer & Georgia Ede, Dr. Iain Campbell at Edinburgh, the Metabolic Mind site and YT channel, and the research getting funding from Baszucki Group with great interest. From what I can tell, ketogenic therapies are going to revolutionize the field of mental health in the coming years.