Ok, I wasn't expecting to hear those words. "Neurotic" doesn't sound good, rhymes with "psychotic", and besides, why is this new psychologist making such pronouncements when he is first getting to know me? Well, because that's what he's paid to do, I suppose. So I went home and looked up the definition.
Neurosis: a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality (which would be psychotic) .
What I also found out was that this is a general category that is no longer in widespread use by the psychiatric community. There are some things I agree with, other things I don't. I've never lost touch with reality. That I agree with. "Mild mental illness"? When one is so depressed that getting off the couch is a challenge, that suicide seems reasonable, one would not describe that as "relatively mild". "Not caused by organic disease?" My understanding of being bipolar is that it is indeed organic, having to do with certain imbalances in the chemistry of one's brain, and not just a symptom of stress.
So, I'll talk with the doctor about his next time.
Mental health diagnosis is often, it seems, a judgment call. Psychiatrists and psychologists often argue amongst themselves. Some are more prone to certain diagnoses, others see such conditions as much less common. I'm confident in my diagnosis of Bipolar Disorder. The reason is that my depression did not respond to antidepressants, but did respond to mood stabilizers. Bingo. That's Bipolar.
But even within that, Bipolar I or II remains a judgment call. It has to do with the degree to which one has experienced manic episodes. What are the symptoms?
"In order for a manic episode to be diagnosed, three (3) or more of the following symptoms must be present:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Attention is easily drawn to unimportant or irrelevant items
- Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)"
There are other less technical associations, such as being delusional, or losing touch with reality, but that's not actually on the list. Though "inflated" is a bit out of touch with reality. As is "grandiosity".
One of the struggles with an exact diagnosis is that during a manic episode one feels good and often doesn't seek help, though others may recognize that things are getting out of control if they know what to look for. My last manic episode was shortly after going through chemical dependency treatment. I resigned my call and went into business, spending about $60,000 in the process, I took over my therapy sessions and had my psychologist simply listen as I did my 'fifth step', etc. My feeling great at that time was credited in part to the 'blue cloud' of recovery, of getting my life back on track, etc. And the diagnosis of being Bipolar had not yet been made. Had my health team been looking for signs of mania, they would have recognized it. Bottom line, one of the difficulties in making an exact diagnosis is that they have not directly witnessed a full blown manic episode.
But also, I believe, is the fact that the difference between mania and hypomania is really a matter of degree and not type.
"You're somewhat egotistical." That was also in the notes. Truth is that depends on whether I'm in a manic phase or a depressed phase. When I'm manic, I'm prone to believe I'm one of the best pastors in the ELCA. On the other hand, when depressed I feel like a total failure, and that everything was for naught. To an extent, both beliefs are delusional. Out of touch with reality? Well, yes, I'm neither the best nor the worst. Reality is somewhere in between that.
I look forward to working with a new therapist. Maybe some new insights will be helpful. Among other things he talks more. And maybe I need to listen more.
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