Be wary of sloppy diagnoses when seeking psychiatric care
There’s a substantial overlap in various symptoms, so it’s not uncommon for disorders to look alike
I could tell the clinician was driving the PTSD (posttraumatic stress disorder) bus early on.
This was during an assessment at Toronto General Hospital, last summer. I went there on one of my quests to find a regular therapist. We sat in a closetsize room — someone sobbing in the room next to us; the walls seemed to be made out of paper — for two hours as I answered questions about nightmares, flashbacks and if I had obsessive memories of a traumatic event. These particular questions were what gave the assessment away.
I wanted to end the assessment. Then I thought how my ending the assessment would probably signal some kind of mental disturbance: I was mindful of the story of a note-taking pseudopatient in the 1973 study by psychologist David Rosenhan, On Being Sane in Insane Places.
In the study, eight non-psychiatric patients — including Rosenhan — showed up at different psychiatric facilities claiming to suffer from the same auditory hallucinations. Despite their symptoms being identical, the diagnoses varied slightly but all of the pseudopatients were admitted to mental-health institutions.
During their institutionalization, the pseudopatients were taking notes for the purpose of the study. In one instance, the taking of notes was labelled pathological, an evidence of mental-health illness.
The study served to expose problems with sloppy psychiatric diagnoses. Rosenhan wrote, “Any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one.”
He also pointed out that getting a psychiatric diagnosis carries with itself stigma that could have personal, legal and social implications. As it does even now, 41years later.
One of the reasons for errors in diagnosis is the fact that “the clinical picture of diagnosis can change over time as a person develops in their illness,” says Dr. Andrew Lustig of the Centre for Addiction and Mental Health. “So sometimes a diagnosis that a person gets at one point (early) isn’t accurate at another point as the condition progresses.” Also, there’s a substantial overlap in various diagnosis, “so it’s not uncommon for one disorder to look like another.”
As for me, back on the PTSD bus, the clinician said she consulted with her group of advisers and it was decided I showed lots of evidence of having a PTSD. I didn’t ask if there were any other possible diagnoses. I wondered if agreeing would get me a therapist faster, but I didn’t want to spend therapy trying to extract trauma from where there was none. Was 2014 a PTSD year? I remember lots of friends getting diagnosed with adult ADHD (Attention Deficit Hyperactivity Disorder) the year before that. Although my own evidence is purely anecdotal, it does seem that like with parachute pants, certain mental-health disorders are more “in” than others given a season.
In 2013, one of the proponents for official recognition of ADHD, Dr. Keith Conners, called over-diagnosing of ADHD “a national disaster” (in the U.S.) and suggested that the increased numbers of diagnoses correlated with pharmaceutical compa- nies’ pushing-pill practices.
But perhaps it’s something else besides pharma companies’ manipulation. It could also be a problem of imperfect science.
Lustig says, “Making diagnosis in psychiatry is primarily subjective or observational — at this point there’s no biological confirmation such as blood test or EKG. But one way to get the most accurate picture is to make sure that the clinician has access to all relevant information: medical records, school reports and other sources of information such as an interview with a family member.”
A successful former costume and set designer, Torontonian Lindsay Anne Black suffered from mysterious symptoms such as clouded vision, rashes, chest pains, disorientation and was at one point given the diagnosis of panic disorder. She was prescribed benzodiazepines, which made her black out.
“In more recent years, such disorientation, lost time, as well as terrifying hallucinations have happened with allergy pills, cold medication and plain old Tylenol. What I now know for sure is that if you are allergic to chemicals, you probably shouldn’t eat them,” Black says.
It turned out Black has something called Multiple Chemical Sensitivity, which is considered a disability and is still a largely unknown condition. The point is, it’s not a psychiatric disorder. Why did it take so long to arrive at this conclusion?
The answer lies in how a diagnosis is arrived at. Lustig says, ideally, a clinician should try to get a longitudinal view, “meaning, be able to see the patient over a period of time with substantial intervals between visits. Someone might present depressive at one time but manic at another.”
Or turn out to be allergic to chemicals. This is why giving a full history to a doctor is crucial.
“Another way to protect yourself as a patient is to be informed about your diagnosis by asking the clinician what do you think my diagnosis is and what are other possibilities?” Lustig says.
I’ve never asked the PTSD clinician if there was something else she thought was wrong. I should have. Just because we rely on specialists, it doesn’t mean we shouldn’t be taking a more active role. Jowita Bydlowska is the author of Drunk Mom, a memoir. She is writing a series of columns on mental health.