This is not a confessional, though I 

need to tell my story as an example

of a bizarre medical phenomenon: psychiatric diagnosis that vacillates with the tide of popularity and social approval. 

After long and wretched experience, it seems to me that psychiatric diagnosis is as mercurial and influenced by trends as high fashion clothing or ice cream flavors. Though I can't begin to write a detailed history of this phenomenon, I will use my own case as a fairly good example of "flavor of the month" psychiatry. 

As a teenager, I was a “troubled” kid, overweight, underconfident, shy and withdrawn: in other words, "psychologically disturbed". My parents sent me to a psychologist who ran a battery of tests, told me I was intelligent, introverted and androgynous (because in answering the question “if a light bulb burned out, would you change it yourself or ask a man to do it?”, I chose the former).  In other words, psychologically disturbed! But there was good news. He said I'd grow out of it: "Don't worry. Now go on and live a normal life."

I had only one suicide attempt in the next ten years, so my disorder seemed to fade away fairly uneventfully. With only a few minor skirmishes, I got back to the business of being normal, raising kids, holding down a job, pursuing my writing ambitions and enjoying my friends. My marriage was stable, and for the most part I was happy.

Then when I was 25, I had a major “episode” - wild flights of fancy, extreme insomnia, racing thoughts, dramatic weight loss – followed by a sickening crash into very deep depression. I ended up in the hospital, and my then-shrink, a classic Freudian, chastised me for being a “bad girl” and labelled me “passive-aggressive”.

And so it went. I had long periods of doing very well, functioning well, even enjoying my life, then the railway car would completely derail. The way I was treated was always faintly moral, as if I had in some mysterious way brought this on myself.

I don’t remember the first time the “manic-depressive” label was slapped on me: perhaps after one of my disastrous plummeting mood crashes(and never did psychiatric staff ask me what happened before the crash). But there was some doubt. The current doc said, “We have a test to determine if you’re really manic-depressive. We put you on lithium. If you get better, you’re manic-depressive. If you don't, you’re not.”

The test didn’t work: I didn’t get better within the 3-week time frame allotted. At the age of 35, I had the default diagnosis of borderline personality disorder, with a side of fries (narcissistic/histrionic disorder). I remember I was given a magazine article that said personality disorders were essentially untreatable. But they had to give me something: so the treatment du jour was the revolutionary SSRI antidepressant, Prozac.

Prozac was Superman in a green  capsule, a phenomenon touted as the miracle drug of all time. It cured depression, it solved life-long emotional disabilities, and it even transformed the personality from introverted to extroverted (which I obviously needed), so I just had to get on-board.

A little side story: on Prozac, I couldn’t have an orgasm. This had never happened to me before, and when I finally summoned the courage to tell my doctor, she said, "Oh, that's psychological. You've made a trade: you've given away your orgasm in exchange for feeling better. But is it really that important if you’re finally getting some relief?” In other words, I was expected to forfeit sexual pleasure – forever! – in exchange for a state of at least improved well-being. (Though I was then told that Prozac caused sexual dysfunction in something like .2% of cases, I later discovered it was at least 20%.)

Oh, but that wasn’t the end of it. Like a lot of people with intractible mood disorders, I drank too much, and when this escalated to the point of disaster, my then-doctor (an alcoholism specialist recommended by my AA sponsor) said, “You’re just an alcoholic. Forget all that psychiatric stuff, it's bad for you." He took me off all my medication, and I became instantly and infinitely worse. So I changed doctors again.

My next diagnosis was a rediagnosis:  borderline personality disorder (“Alcoholism is really a very small part of your problem”). Then the psychologist I saw for five years told me I had dissociative disorder (connected with recovered memories of sexual abuse: remember them?). 

I seemed to be trying on and discarding one pair of diagnostic shoes after another, still unable to find the ruby slippers. One corporate psychologist I briefly saw in my mid-30s even said, “You know, I really think you’re manic-depressive. It can look like a lot of other things, but the overall pattern of your life indicates that you have it. But don’t worry, you’ll probably mellow out when you’re in your 50s.”

One might ask, why did I go to all those different doctors? Some refused to treat me after I failed to improve. Some accused me of holding out for a “better” diagnosis, or of not being compliant enough (the ideal trait in a psych patient). I made up a bitter little song: “Have you ever seen a nut case go this way and that way, have you ever seen a nut case go this way and that.”  Then, after seeing the recovered-memory psychologist (post-traumatic stress disorder!) and a long period of sobriety, something happened.

I got better.

It wasn’t perfect, but the “better” lasted for fifteen years. All my former diagnoses were apparently called off, cancelled due to lack of relevance.  My cohorts in AA told me that if I didn’t drink, I’d never have an episode again.

But in 2005, everything blew apart. I had a manic episode so classic that even my blinkered doctor had to take a second look. She treated it with a triple dose of standard antidepressant (the worst treatment possible for a manic bipolar), which I now realize probably tripled my symptoms. I barely got through it alive.

When I walked into the office of my current psychiatrist (recommended by a close friend whose partner had gone through the same protracted hell),  I burst into tears. But I didn’t get that judgemental scowl, that suggestion I was overdramatic and a malingerer (a term I had actually heard before). He did a long and careful history and concluded that in his opinion, I did indeed have bipolar disorder.

Though I was extremely skeptical, the drug cocktail he cobbled together gradually began to work. He told me that significant relief could take a full year, perhaps two. Ironically, the main drug on the menu was lithium, which given more than a couple of weeks' trial turned out to be quite effective. Equally important was his palpable respect for me as a human being and a psychiatric survivor who had always worked very hard to hold on to her mental health. But as far as diagnosis was concerned, I found myself almost back where I started.

I began to notice something. People who had been labelled with other disorders in the past, particularly personality disorders, post-traumatic stress and MPD (multiple personality disorder: remember Roseanne Barr?) were now being relabelled as bipolar. When I pay close attention, I see bipolar references everywhere.

Psychiatry is an inexact science, and mental disorders are notoriously fluid and resistant to being pinned down. They ebb and flow with the tides of life, not to mention the individual temperament of the patient. But a disease is a disease, is it not? Why is misdiagnosis almost standard in psychiatry? Why is it tolerated? Why such trendiness in a field as agonizing as mental illness, with patients expected to force themselves into the mold?

In 2009, bipolar disorder struts down the runway, long-legged and glassy-eyed, dressed in bizarre, unwearable garb: it’s the latest fashion in psychiatric “insight”, and you just have to get on-board if you want to get better. Forget Prozac: nobody takes that any more (in spite of it making the cover of Time Magazine in the '90s like some high-profile politician). Forget dissociative this and personality that. This is a genetically -based brain disorder, a neurological condition not much different than Parkinson's or MS. Like diabetes, it can be “managed” (oh, how often we hear that one!), but never cured.

But it’s not like there was a banquet of wretched psychological inadequacies laid out on a table, and I chose bipolar. It’s always someone else who decides. When I asked my psychiatrist why diagnoses seem to shift over time like this, he said, “Well, we know a lot more about bipolar disorder now.” Fair enough. But he added, “The shrinks around here used to have an alarming habit of diagnosing various kinds of personality disorder. I don’t know why, except that their colleagues were doing it, and it kept them in business. Things are swinging back the other way now, and it’s about time.”

I’m not saying I’m NOT bipolar. But I refuse to believe it’s the one true religion. What alarms me now is how obvious it was that I was having severe mania followed by severe depression ALL my life, and even though it was right under my doctors’ noses, they did not see it. They did not see it because it wasn’t what they were looking for, and it wasn't what they were looking for because it just wasn’t on the screen.

There may be another factor: Kay Redfield Jamison writes in her harrowing memoir An Unquiet Mind about how society tolerates and even admires mania in men (especially creative men: caught up in fiery inspiration!), but frowns upon it in women (the bitch is out of control!). So mania in women, unless it’s pretty extreme, flies below the radar and is often explained away as a case of hormone-driven hysterics. A depressed, downtrodden woman is easier to manage, and gains more social sympathy, than a bitchy, out-of-control one.

After decades of pain and misadventure, I’m tired. I think I’ll settle for bipolar, mainly because the other labels were so disrespectful, inaccurate and unhelpful. We have to call it something, after all.

But I’m unsettled by how ubiquitous it has become. All those other categories appear to have been swept under the rug, or cancelled due to lack of interest. Recovered memory and all its concomitent disorders is shot: let’s burn those hundreds of sensationalist memoirs and magazine articles, shall we? And what do I do with my dissociative disorder, anyway – put it in a yard sale? Can I sell a bad case of used narcissism? And how about Prozac: shall we just flush this out-of-fashion miracle cure (along with all the other psychiatric chimeras of the past century) down the toilet where it belongs?