Do Medical Professionals Know Best When It Comes to Bipolar Disorder?

[Music] Too long didn't listen? Here's what you'll learn. The pitfalls of getting information from our friends and the pitfalls of getting information from our providers and why the side effects of psychiatric medications are just never going to sound sexy. How we as bipolar patients can better advocate for ourselves, but we need to know when to advocate and when we should be listening. Learn how we as patients need to accept that as much as it feels like providers can sometimes be against us, it's simply much more nuanced than that. Entrieg and want to know how we arrive at these conclusions? Keep listening. [Music] You're listening to Inside Bipolar, a helpline media podcast, where we tackle bipolar disorder using real-world examples and the latest research. [Music] My name is Gabe Howard and I live with bipolar disorder. I'm Dr. Nicole Washington and I'm a board certified psychiatrist. All right, Dr. Nicole, you're a board certified psychiatrist. So you are the best person for me to ask, what is the medical definition of bipolar disorder? That's a great question, Gabe. When we as psychiatrist or anyone in the mental health field think about bipolar disorder, we think about two mood episodes, either depression and mania or depression and hypomania, depending on which type of bipolar disorder a person has. But in between those episodes, there can be extended periods of what we consider a normal mood. All right, Dr. Nicole, everybody now understands bipolar disorder. Right, because we just rattled it off in like three minutes. But what about the treatment for bipolar disorder? And in fact, don't bore us with the treatment for bipolar disorder. You probably had to go to medical school for eight years to learn that. Where are the pain points? Why aren't patients and doctors connecting? Because it seems to me, bipolar disorder is well understood. Doctors like you are readily available. Patients want to see doctors. Shouldn't this whole problem just be resolved? I sure wish it were, but that is really not the case. When you think about the typical medication that we use to treat bipolar disorder, and you go look up those side effect profiles, which most of us have, they do not sound sexy, right? I feel like a used car salesman sometimes trying to convince somebody to take medication because I am obligated to do the, like, these are the side effects that you need to know about. And I just sometimes can't make them sound great. I'm left really trying to convince somebody that they should take the meds despite the potential negatives, which if you look them up, yeah, none of them sound like anything anybody would intentionally sign up for. So that's, I think, a big battle. Plus, when people have been hospitalized, they learn about these meds, right? In their communities, in the hospital. And so you might recommend a certain medication to somebody. And they say, oh, no, when I was in the hospital, those people that want on that, they look like zombies, or they look like this, or that. And it's so hard to get people to understand, we can't compare ourselves. Our body chemistry is different. We're going to respond differently. I can give two people the exact same dose of something. And one of them will say, I felt like a zombie. I felt sedated. I had no emotions. And the other person will say, I felt great. So there's a disconnect there and what they see, because they sometimes see people have really negative effects. And then when they look up the side effects, it just doesn't sound sexy. It's fascinating to me that you admit, like just in front of me, in the whole world, you're like, yeah, sometimes these men have side effects that suck. The patient community is like, my doctor doesn't care. My doctor lied to me. We get that one a lot. My doctor told me that I would not gain weight in that I did. Or my doctor lied to me and said there'd be no side effects in their were. And then of course, there's my favorite one. My doctor got paid to put me on this medication and doesn't care about me. There's little kernels of understanding in all of those things. I want to clear up one thing. Pharmaceutical companies are not allowed to pay you. That is correct, right? That is absolutely correct. Okay. Now the pushback that people get is, but they're allowed to buy you a lot of food and send you on vacation. What are the rules there? No. So back in the day, before I was even like really practicing, that may have been true. You would hear of drug companies hosting golf trips or ski trips or things like that for doctors. I mean, that was true. Back in the day, you would have these very, very luxurious dinners and things like that. They have really cut down on that in recent years. I hear people with bipolar disorder constantly complaining about their providers. And I'm not saying there's not room for improvement, but I always ask them like, well, did you ever discuss it with your provider? Or are you just complaining behind their back? And listen, it's almost always they're complaining behind their back. It's tough on my end, right? Because in psychiatry, we have all these boundaries that we have to be aware of, even more than most physicians. And the reason for that is if you think about it, most patients share things with their psychiatrists or their therapists that they may not have shared with anyone. And so for them, our relationship is very different, but I have to try to remain as neutral as possible. And so then I have to create a lot of boundaries that sometimes people don't like. They don't enjoy. And I have to remind people sometimes that I am here, I am part of your team. I am here to support you, but we're not friends, right? Like I'm not the person you should call to say, hey, have you been watching the Olympics? You know, I was just wondering what you thought about blah, blah, blah, like random calls. And believe me, I've gotten those. And I think it's because people get really close to you because they share things with you that they just don't share with other people. And so sometimes those lines get blurred. I imagine it has to be very difficult. I'm thinking about me, like I just, I suffered for so long. And I didn't know why. I just had no idea why. Now I was super lucky and that the person who took me to the hospital was the person that sort of imprinted on me. I was like, oh my god, you know everything. And that person was my friend. So the boundaries were very different. But I can only imagine if I was taken to the hospital by an ambulance or by police or by a 911 call. And the first person who explained what was going on in my head was a provider, was a doctor. And I think, you have figured me out. Oh my, I would follow that person around. Like, I mean, the person who took me to the hospital, I did follow around. Like they were just some sort of clear-voyant. I mean, it was kind of amazing, honestly. But how do you deal with that? Because again, I have to imagine when you tell people, not only what they've been suffering from has a name, but that you have a solution, they want to be your friend. Some of them do, but you know, some people are not as happy about the diagnosis, right? So there goes the stigma. Because you would think, you know, on the one hand, there are people who are very appreciative and think, oh my gosh, thank you for putting a name to how I've been feeling for the past however long. And thank you for having a solution. But there are some people who are so, they are so upset at the thought of having bipolar disorder or being bipolar as, you know, I don't want to be bipolar. Right. And they are so upset about that that they will refute what I'm saying. They will tell me I'm wrong. They will come up with every reason in the world why these things happened instead of their actual reason. And so not everybody is really warm and fuzzy about it. Some people are pretty upset. Do you find that more people take the news negatively and don't want anything to do with it? More people take it positively and they're like, oh my god, it's like their aha moment. Is it 50/50? I think the setting matters, right? So in the hospital setting, you think if somebody's coming into the hospital and to an acute hospitalization due to mania, especially in a manic face, they're not necessarily in the best space to hear what I'm saying and not necessarily having the best of insight at that moment. So sometimes that's tough. That's a tough place to be. To convince someone who's in the middle of a manic episode that what they have is bipolar disorder. Sometimes that's really difficult. In the outpatient setting, I don't find it to be as negative of a reaction when I talk to someone about bipolar disorder because I can have an actual conversation about this is what it is. This is what it isn't. This is why these things happen. You know, let's go look at some reputable sites and do some research between visits and come back and talk to me about it. It's a much easier conversation, whereas in the hospital with someone who's acutely manic, all bets are off. What I felt like is that I'm going to have to move into a group home or that I'm soon going to be dead because I thought bipolar disorder was fatal and I thought every single person with mental illness lived in, I don't know, I guess a group home is what I thought. I did not realize that it was a manageable illness because I just didn't know anything about. I only knew one person ever, like a famous person who died by suicide and I thought, well, if a rich guy can't beat it, I'm just honestly, I felt like relief is probably not the right word, but I accepted it immediately. I was like, hey, I'm reading the pamphlet. This describes Gabe. Do you think that was affected by you said you had a friend who was involved in your care? Do you think that was affected by the fact that you already had some level of trust in the treatment team or the setting? Here's, I was tricked into going in. of the emergency room. Straight up, I thought that suicide was normal. I thought about suicide literally from birth. I was just, I was born this way and the problem with thinking about suicide every day since birth is that you think it's normal. This is normal. You think that that's what other people are thinking about. I just, I always use the example that even though I've never seen my mother go to the bathroom, I know that she goes to the bathroom. I don't, I don't need to see it to know it. So even though I'd never heard many people talk about suicide, I just assumed that they were in fact thinking about it. It didn't occur to me that, yeah, I, listen, I had bipolar disorder, all right? My thinking was not great. So when she came up to me and she recognized the signs of suicidality and mental illness and she decided to intercede to do something and she said, hey, are you planning on killing yourself, right? She, she did it perfect. I mean, she literally did it perfect. Like she'd taken a class. She didn't mince words straight in the eyes. I mean, it was, listen, it was, it was wonderful suicide prevention. But I had no reason, a lot. I was like, yes, yes, I am. And I thought that meant she was going to help me. Like sincerely, I thought this meant that she was going to assist me in my plan. But instead she wanted to take me to the emergency room. I thought she was nuts. It's pretty interesting that you even brought that up because that is a common theme. So I will ask people as I'm doing my questioning, do you have a history of suicidal thoughts? And I cannot tell you how many people say, well, yeah, I mean, everybody does. And I will come back with, well, everybody doesn't. And I will often get this deer in the head like, look, like, what do you mean? Everybody does it. But it is said just as casually as you say, like, yeah, everybody goes to the bathroom, like everybody. And it floors me, what floors me for years. And now what you're saying makes a lot of sense. If you have just always been this way, you just assume that everybody has it and just doesn't talk about it. A light bulb has just gone off a top my head. Well, I'm very glad that I could be helpful. I mean, I don't want to pat ourselves on the back. You and I came up with the idea of the show for a reason. So I mean, we obviously believe it. But I do believe that not enough people are talking about it because the connections they're just missed. They're just so missed. Well, how could you think that? Well, why wouldn't I? That was the first thought that popped into my brain and nobody ever challenged it. Listen, I went to public school in the 80s. There was no psychology class. There we weren't talking about mental health. My family is stereotypically blue collar. I don't say that to trash them in any way. I'm just saying my father, he believes that any problem that befalls a man can be resolved by rubbing mud on it. You know, he's a tough guy. Now he's like 70. So now he's a tough guy with a hunch. But still, the tough guy is still in him, Dr. Nicole. I mean, people are like, well, why didn't your family talk to you about this? How would this work? Could you imagine my family sitting 10 year old gave down and saying, hey, do you think about ending your own life a lot? They had no reason to suspect this. We don't teach parents how to have these conversations. But these conversations are super important. Now we've been sort of talking about bipolar disorder in terms of depression and suicidality because if I understand correctly, that's sort of the number one way that people end up getting help after a suicide attempt or their families are worried that they might die by suicide. Suicideality and bipolar disorder are intrinsically linked. If please correct me if I'm wrong, but assuming that my Google search worked out, about 15% of people with bipolar disorder will die by suicide. That's a scary number. It is a scary number. And you're right. We don't talk to children about this kind of unless your mom's a psychiatrist because I will tell you, we all need Dr. Nicole's our mom's. I will tell you at random moments, my children will tell that I will sit them down and just, hey, how's it going? How are you doing? You know, just randomly. Hey, you know, you're feeling okay? Your mood's pretty good. I do mood checks. We talk about suicide. This is an inappropriate question. So I'm going to ask it anyways. Go forward. Hey, everyone. I'm Gabe Howard, host of the Inside Mental Health Podcast. An award-winning weekly show from Healthline that breaks down complex topics around the world of mental health and psychology. Learn from experts you can understand with me as your trusty guide to ensure it doesn't evolve into a boring academic lecture. We cover everything mental health. So pick the episodes that interest you and remember understanding your mind is the first step to a healthier you. Subscribe and listen to Inside Mental Health on your favorite podcast platform. Health German. Psychcentral's talented team, award-winning writers, editors, and medical professionals, are passionate about creating a safe, inclusive, and trustworthy environment where you feel seen and hurt. Visit us now at psychcentral.com. That's psychcentral.com. And we are back discussing the missed opportunities between patients and providers. The number one thing that I hear in the patient community is my psychiatrist is mean because they want to build a tennis court and they want to hang out on their yacht and they don't care about me. I know you're Dr. Nicole and I can't help but notice that you don't seem to have a tennis court and you don't seem to have a yacht. Is this a barrier to patient provider connection where many patients believe that all doctors are millionaires riding their horses and playing tennis on their yachts? I've had patients tell me that they know that I'm a millionaire or that they know that I get extra money by diagnosing them or I get extra money from drug companies or I'm getting rich off of keeping them in the hospital. It is amazing the things that people think and I don't know if people just think doctors are inherently wealthy. I don't know if they also know how much student loan debt we have compared to our incomes in general but I can assure you I don't have a tennis court or a yacht. I don't even have a pool and I would love to have one but I don't because I cannot cannot cannot afford to do such a thing right now. What was soon as you said that I thought oh man my dad's a retired truck driver and he has a pool. I know. I know. You need to switch to truck driving. I may well I don't I don't know I fall I get sleep in the car so probably truck driving wouldn't be a great career for me. I wouldn't give very far. Plus he's like super grumpy and you're super nice so everybody wouldn't say that game. Everybody wouldn't say that. You know my dad he's a super grumpy guy. He just really is. I love him of death. He's done a lot for me. Super grumpy guy always sleep deprived. He had a really hard job until he retired and I just I remember one time we all went on vacation and we stayed at a hotel that my dad stays at when he when he drives the truck and because they they gave him the trucker rate because it was a ski lodge that was off season. So just here we are we go into this place and of course they all know my dad they they see him two three times a week as part of his route. He's he's staying there all the time they all know and all of these people are talking to my dad like he's a fun guy and I'm just like what what a earth is this and my dad is talking to them and tones of voices and in in mannerisms and he's doing things I have never seen my father do and sincerely I am glad that I have that experience you know I was younger I was about 1415 and I realized oh my god my dad is a completely different person when he's not being a dad he's got no responsibilities it everybody 600 miles away so I got to see this idea of my father just as a person and not a husband or a dad right and I I genuinely believe that one of the biggest issues between patients and providers is we only see each other when we're largely often in credit not not largely but we see each other when we're in crisis we see each other when things aren't going well and we see each other in this setting in this medical setting and then we extrapolate largely based on well bullshit we extrapolate what's going on after the fact and I know both sides do it I'm going to stick up for patients I I know that the medical community office like well why won't you take your pills yeah because I can't fill them because I don't have insurance because I'm broke but do you feel that that is a barrier to care I think so I mean that people yeah I mean I'm sure people think that I'm just sitting around reading the DSM for leisure in the evenings you know wait you're not no no no even I thought that was true no no no no no sometimes I use it to prop things up and lift my computer up and all kinds of stuff but you know when I'm outside of work I'm actually a real person you know my kids would tell you I'm a nice mom and you know I'm a real fun person but in that moment you're right like we have our boundaries and we have to keep them tight right like we have to keep them tight and so and we have limited amounts of time right so in the 20 minutes that I'm going to see you you don't really have time for me to share the fun side of me with you because you're paying for me to figure out are you okay what's going on what do we need to do we don't have time for the the the grandin and laughing and all that stuff but the grumpy right so you sell my dad's grumpy well from your perspective But from a patient to a doctor perspective, what kinds of things do you think doctors do that come across as grumpy? Because maybe we don't know that it comes across as us being mean. I think you said mean. You said that patients think doctors are mean. What types of things do you think that doctors do that patients think are mean? One of the things that I have noticed and that I hear a lot in the community is the disconnect on goals. I give a speech and I, you know, for providers, largely therapists. I want to be honest. There's usually not a lot of psychologists, psychiatrists in the room there. They're usually therapists and I say things like what are the goal for your patients with serious and persistent mental illness? And they say things like show up for the appointment on time, be med compliant, participate in their treatment plan. And I always point out that there's the disconnect. If you ask the patients what their goals are, it's to go to Hawaii. It's to get a job. It's to fall in love. It's it's worlds apart of difference. But here's the thing. It's that misconnections thing that I thought see that they're so connected. They're just so connected that the patient is going there to like I said go to Hawaii, get a job fall in love. And if you can understand the treatment plan, if you can get on board with it, if you can take the medication as prescribed, if you can, that will get you closer to your other goal. But the disconnect right there is that a lot of providers are just like, well, if they would do what I told them to, they would be fine. Listen, walk up to any adult. Forget about mental illness. Just walk up to any adult and tell them to do something. And I would bet you a hundred percent of adults would dig their heels in. And those are uncompromised, unsick, untraumatized people who just don't like to be told what to do. This is we saw from the mask mandates how America just lost their mind at this idea of just having to wear a little piece of fabric over their face because they don't like being told what to do. Not to fall down the rabbit hole on this one, Dr. Nicole, but you can imagine if that's how normal people reacted to something as simple as a mask, you can imagine how somebody who's compromised, who's traumatized, who has probably been, I do hate this word. I wish we had a lighter word, but abused by the system and generally small abuses like having to wait six weeks to see a doctor, having their appointments canceled a lot. These are, these are like micro abuses, right? But they feel like the system doesn't care about them. And then they get lectured that they're not mid-compliant or told what to do by a provider. I think that lack of control thing is huge though because one of the things that will happen is a person feels like they have no control. So you think about someone maybe newly diagnosed with bipolar disorder or even they've had it for a while and they struggle with the diagnosis, right? You have all these people trying to tell you what to do when to do it. Take this medicine at this time of day. Go to bed at this time. Forget about the hospital, right? Like go to bed at this time, wake up at this time. You can only eat at these times. You gotta go to group here. You gotta do that. And we see a lot of patients, I guess, rebel for lack of a better word because they're like, no, I'm an adult. I don't want to go to bed at 9 o'clock. I want to stay up to 11. No, I don't want to eat now. I want to eat now or from now. So you see a lot of that and it does come back to control. And so a lot of times, I think the big work outside of the hospital with someone who's struggling is to figure out, you know, let's figure out where they can get control back because you're right. Whenever anybody feels like they are losing control of their rights or their ability to say yes or no, I do or don't want to do whatever it is. It's gonna be bad, you do bad, you do. But Dr Nicole, in a way, it also shows progress, right? They're trying to take control of their own lives. One of the things that I often hear from the medical establishment is that, well, they're not investing in their care. They're not taking control of their lives. They're not doing what they need to be doing to get well. They're uninterested in getting better. And I think, okay, well, what exactly are they doing? And you say things like that. They don't want to go to bed at 9 o'clock. They want to go to bed at 8. It sounds very much like they are trying to control their lives. Just not in the way that you envisioned for them. Yeah, it's a fine line. I struggle a lot. I do get into those moments where I'm like, take the medicine. Just take it. Let's just take it. Let's just see. Let's just take it. And you want that to happen so badly, right? But it's not because I just want you taking pills. It's because I know that taking the medicine can help you then achieve those goals that you have right to get the job to be in a relationship, to go to Hawaii, all those things. And I know that that's the intermediate step. Unfortunately, it doesn't always come out that way. It doesn't always come out that the person prescribing the medicine says, Hey, I think if you took the medicine though, it could help you with a B and C. If you do those things, those are the first steps for you to get to where you want to be. And have that conversation. I think that's where maybe some of the disconnect lies. But I will admit there are times when I'm extremely frustrated and let's be honest, there are times that you can't have that conversation because the person is not in a in a good enough head space for you to have that conversation. These are the challenges of the bipolar community. And I'm so excited, Dr. Nicole, to do this podcast with you because listen, we'll give you advice. We'll give you definitions. We'll tell you stuff. But you can Google that, right? You can get on healthline.com and psychcentral.com and find out all this information that you want. Our goal with this season is to talk more in depth. And you know, I really like the sound of my own voice. So a podcast just seemed like the best fit for me. Dr. Nicole, did you have fun on your first episode? I think it was fan freaking. Tastic actually. I love it. I love it. Dr. Nicole, it was fan freaking. Tastic into all of our listeners. Thank you so much for tuning in. You have been listening to Inside bipolar. My name is Gabe Howard. And I am the author of mental illnesses and asshole and other observations, which is on Amazon because well, that's where everything is or you can learn more about me and get the book signed by heading over to Gabe Howard dot com. And my name is Dr Nicole Washington and you can find me at drnacole psych dot com dr and I see OLE PSY CH dot com to see all the things that I have my hand in at any given moment. Wherever you download of this episode, please follow or subscribe. It is absolutely free and hey, can you do us a favor share the show with a friend or a colleague, whether you send them an email, a text, social media, hey, you know word of mouth is still a thing. Just please share the show because it's how we grow. We will see everybody next time on inside bipolar. You've been listening to Inside bipolar from healthline media and psych central dot com have feedback for the show email us at show at psych central dot com. Previous episodes could be found at psych central dot com slash IPP or on your favorite podcast player. Thank you for listening. [BLANK_AUDIO]