Dissecting a Diagnosis.

I traditionally put a lot of stock in a diagnosis.  It made, what was otherwise dismissed or denied in my adolescent years as teenage angst, feel real, acknowledged, validated.  That need for a diagnosis persisted over the years, it felt like the only way I could get the world to see I wasn’t lazy, too emotionally sensitive, and irresponsible. 

In the mid 90s, the first phrase that entered my ether, was “clinical depression.” This was a medical depression, not an everyday depression.  It required treatment.  And I was referred to a psychiatrist and prescribed antidepressants and became part of what was dubbed “Prozac Nation.”

I heard unipolar depression, to distinguish it from its counterpart bipolar depression.  Unipolar is only depression, bipolar is both depression & mania, manic depression.  I was clearly unipolar.  Mania was a euphoria, and energy, out of control and destructive —  I didn’t experience this.   

Then I read about severe depression and dysthymia.  Dysthymia was a low-grade chronic depression that lasted for years.  Severe depression was more episodic, and as the title explains, more severe. 

At my first psychiatric hospitalization at age 15, the doctor said I had Double Depression.  That he explained, was dysthymia mixed with episodes of severe depression.  The way he described it, I was always below a healthy person, below a baseline.  When I had an episode of severe depression, I’d spike further down and when I would bounce back, I could go up, but only back to below the baseline.  

Mental health professionals, also believed I had Seasonal Affective Disorder, SAD as it’s un-ironically called. This means my depression worsened in the winter months, when I didn’t get exposure to enough natural sunlight because the days were shorter and the cold meant more time indoors.  I got one of the very first models of a sun lamp, which looked like my own private tanning salon, and emitted a frequency that repeatedly turned my stereo on and off. 

But with SAD, dysthymia and severe depression, didn’t I have TRIPLE depression?

In the late 2000s, the categories had changed.  I decided to take the diagnosis in my own hands this time, courtesy of google.  I have atypical depression, aha!  It means you can still experience moments of joy.  It means you get heavy-laden limbs, where you feel like you can’t move your body.  This is it! This will explain my inconsistent moods, my sensitivity to rejection, my 14-hour days asleep in bed!  I never discussed it with my doctor, I just took some anti-narcolepsy drugs used experimentally to combat depression, a new wave of antidepressants and pushed through a truncated relapse. 

Now it’s 2014 at the mental hospital. Oh and you self-harm? At your age? Then you are without a doubt, you are most definitely, someone with Borderline Personality Disorder (BPD).   There are like 9 characteristics, and if you have what seems technically to be 5 of the 9, that’s you.  Even if the 4 characteristics you’ve never had are so far off from your personality and the 5 you do could literally apply to anyone on the planet.  Fear of Abandonment? Seriously, who likes to be abandoned?
If you cut, there is no other explanation.  But you do have a mood disorder alongside, comorbid, especially necessary for insurance agencies who will not pay for treatment of ANY personality disorder. 
But dear mental professional, are you seriously not going to specifically call it depression? But it’s always been DEPRESSION? What?
Let’s put you on a mood stabilizer and find you a way to get you DBT, Dialectical Behavior Therapy for Borderline Personality Disorder.   Or maybe, as one doctor says, acknowledging I don’t really meet the criteria, an unspecified personality disorder.  Or better yet, let’s call it Emotional Dysregulation Disorder.  It’s not in the DSM (Diagnostic and Statistical Manual of Mental Disorders) yet, but we are hoping it will be.  Personality disorders are stigmatized – borderlines are viewed as manipulative abusive liars — and the disorders viewed as untreatable, but this is treatable.  You will learn to regulate your emotions. 

Now it’s 2018.  I’m off my meds but I need to go back on.  Well, you seem to be having totally run of the mill depression, so let’s kick up the traditional antidepressant, called an SSRI, and leave the mood stabilizer behind. 
But wait, what? I’m manic now.  From the SSRI.  Or I’ve always been manic but the SSRI is exacerbating the mania.
But, I can’t be manic, I have UNIPOLAR depression, I have never been euphoric and energetic and out of control.  

Here’s the breakdown, there is mania, and there is hypomania.  Hypomania is a lesser form of mania. 
Hypomania can be either euphoric or dysphoric, meaning it can either make you feel happy or make you irritable.  Irritable, angry and restless.   Dysphoric hypomania, bingo! This is why you cut yourself! The Borderline was a wrong diagnosis, a close but subtle difference in symptoms.  The drugs demonstrate the truth, you’ve never done well on SSRIs because you can’t use them to treat bipolar.   It’s old-school lithium for you now! 

You are what is known as SOFT Bipolar.  No, there is no hard bipolar.  But Bipolar is a Spectrum. And it’s not in the DSM either.  But it will be!  And instead of googling articles, let’s order and read the book Bipolar Not So Much!  It explains it all… or does it?

But you’ve never been actually manic.  Like really manic.   You can’t be bipolar. 

Let’s just keep on coding this as F 33.1 Major Depressive Disorder, Recurrent, Moderate. 

Nowadays, the diagnosis is meaningless.  I read and read and read, but none of the criteria seems to truly fit what I experience.  I wonder if at times, I tried to identify times I’m dysphoric hypomanic, just because it’s my diagnosis and not because it feels real.
The depression always felt real. From the moment I wrote my first diary at age 12 and called it that, without any exposure to what it meant. But it’s so general, so all encompassing, the diagnosis now feels like it lacks the meaning it once gave me.

I don’t know what have, I don’t know what treatment works, I don’t know what new category will emerge in the future to shake up all the current understandings.