Psychiatric Misdiagnosis and Rediagnosis in Recovery
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Psychiatric Misdiagnosis and Rediagnosis in Recovery
At two years sober, prayer, meditation, sponsorship, and AA meetings weren't removing what I thought were character defects. Just as when I was drinking straight vodka, smoking angel dust, and snorting heroin, my mind was attacking me with palpitating anxiety, paralyzing depression, and suicidal ideations. I went to the ER and immediately accepted eight days of acute psychiatric hospitalization. Believing something beyond alcoholism to be the root of my emotional pain, I welcomed the diagnosis of bipolar disorder and felt relieved that there could be a more promising solution that AA alone couldn't offer. This misdiagnosis wasn't the psychiatrist's fault; I had only a limited understanding of my truth and I gave them that information.
The hospital started me on Lithium; I felt stable and safe. My AA friends thought I was overmedicated because I wasn't constantly crying anymore, but I could still feel a range of emotions and knew the dose was therapeutic. I joined a dialectical behavioral therapy (DBT) group and adapted tools for coping with my erratic mood swings. While AA suggests that we are powerless over feelings and need to turn them over to a higher power for relief, DBT taught me that I do have control over my emotional hysteria. It moreover helped me differentiate between situational and clinical sadness. After years of walking on eggshells with myself, I finally felt grounded.
But the severe acute anxiety, suicidal fantasies and catatonic depression creeped back in at six years sober. At a low point, I couldn't leave my apartment for three days. I was suffocated by terrifying, vivid nightmares when I managed to sleep. Amidst panic attacks, I dissociated so badly that I blacked out. Following my therapist's guidance, I let a psychiatrist re-evaluate me. It turns out I didn't have bipolar, which is actually rare; I have post-traumatic stress disorder. In truth, I've never had bipolar mania—only an elated relief of breaking through a depression. My episodes never lasted more than a few days and only happened when something reminded me of horrifying life-threatening memories from my childhood. PTSD describes these patterns. By then, I had been on Lithium for over four years, though my psychiatrist pointed out that the medication wasn't subduing my emotional outbursts. I thereby started treatment focused on trauma healing and tapered off Lithium. My therapist and psychiatrist closely monitored my progress in case the new diagnosis was inaccurate. I think this time we got it right.
My psychiatrist explained that if I feel depressed or anxious daily for two weeks or more, then an anti-depressant would benefit my treatment. I haven't needed to take one yet because my emotional pain has been tolerable and manageable since my diagnosis. For me, medication masks the difficult emotions that tell me there's healing to be done and where that is. Without those essential roadmaps to recovery, I wouldn't know in which direction I'd need to grow. Just as with drugs and alcohol when I was active, I've been emotionally dependent on unnecessary psychiatric medication to numb me in sobriety. I remain open to the possibility of medication aiding me in facing deeper trauma work and won't refuse it if it becomes medically necessary, but I'm proud of myself for making it this far without it. I already successfully walked through an intense trauma relapse without an anti-depressant, so I'm confident I can face anything in the small doses my therapist has been regulating for me.
PTSD episodes are just waves of intense fear that feel real, because trauma memories are stored in the instinctual survival part of the brain instead of in the conscious part of the brain where non-threatening memories reside. The goal of trauma therapy is to rewire the trauma memories to that conscious area of the brain. In therapy, I carefully talk through the trauma while remaining fully present in mind and body (not dissociating) and then consciously choose my course of action in response to a trigger rather than giving into the PTSD autopilot reaction (i.e., dissociating, sweating, shaking). Practicing DBT, CBT, and ACT skills similarly help slow my mind enough so that, when triggered outside of therapy sessions, I can process that the present moment isn't life-threatening like the original crisis. My therapist still gives me books to read about healing different aspects of my trauma. I work on it everyday, and started finding emotional stability after only a few months of treatment.
Today, my flashbacks and triggers are tolerable. The worst I've felt in months is one hour of mild anxiety and sadness (I happily counted), which dissolved immediately with mindfulness meditation. I don’t need to rely on my therapist's phone call to calm down anymore; I have the needed tools within myself to heal. It's built enormous self-confidence because when the emotions arise they no longer overwhelm me. As Marianne Williamson so eloquently discusses in her lectures on A Course in Miracles, we don't have to act from our wounds. Although this is difficult, particularly at the beginning of healing PTSD, I found through my little triumphs that it is possible. And it gets easier each time. The most encouraging part of trauma treatment is that I get to choose to stop my exposure to the trigger as soon as it feels too intense and I dissociate, but it's my responsibility to set that boundary with myself.
My higher power has been the strongest presence guiding me on this path. By no coincidence, my newest sponsee is working through PTSD and our stepwork meetings are some of the most profound I've yet been blessed to experience. I get to show her where AA can help and where a therapist is best consulted. I believe that my higher power never gives me more than I can handle, so every time a trigger pops up, I graciously accept it as an opportunity for personal growth. They're signs that my higher power thinks I'm ready for them, and I take that as a compliment to the progress I've made.
Last year, the man I was in love with suddenly relocated halfway across the world; I traumatically relived the day my primary caretaker moved to Germany which had left me exposed to my physically abusive father's rage and my mother's emotional neglect. Then last month, four close friends moved and I was okay. That I can face my deepest triggers and function both happily and peacefully is a miracle in action and a gift beyond my wildest dreams.
Proper psychiatric diagnosis and treatment has allowed me to be present and available to others. I've found deeper healing in the other areas of my life through the 12 steps because I cleared away the damage that was obscuring the light from entering my life. In the end, it all comes back to deepening the relationship I have with my higher power so I can be still and uncover the divine inspiration from within myself. I love and accept the PTSD emotions that arise instead of judging and stuffing them. I embrace where I need to heal and let healing happen. There will always be another problem to address, but for now, I've made the most impactful start yet on my personal path to emotional and spiritual freedom.
Author Recommended for Further Reading:
Internal Family Systems Model by Richard C. Schwartz, PhD
Overcoming Trauma and PTSD: A Workbook Integrating Skills from ACT, DBT, and CBT by Sheela Raja, PhD
The Drama of the Gifted Child by Alice Miller
Facing Codependence by Pia Mellody
EMDR: The Breakthrough "Eye Movement" Therapy for Overcoming Anxiety, Stress, and Trauma by Francine Shapiro
The Body Never Lies: The Lingering Effects of Hurtful Parenting by Alice Miller