Refused diagnosis. What can I do?

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I'm in the UK and I recently had a first appointment with a psychiatrist. He asked me a lot of questions with the focus being on bipolar disorder. When I asked him if there would be any differential diagnosis, particularly Asperger's or ADD, he told me that we would just be focusing on bipolar. I asked him why and he said Asperger's and ADD aren't recognised as actual conditions.

I pushed the issue further and he said that it would be "pointless" to get a diagnosis of either condition because there's no support available in the local area. This annoyed me a little because, as I said to him, I know of lots of support in my local area and on the Internet, even if it's just talking to other people going through the same thing. I mentioned a support group half an hour away from where I live and he just looked at me and said something along the lines of "surely it would be inconvenient to have to travel to get support" to which I replied that I would gladly travel much, much further to finally get some relevant support.

The conclusion was that I would complete a mood diary for a month, then begin medication for bipolar disorder. Is there anything I can do? I went to the psychiatrist to try to find some answers, not to be given random medication for a condition I probably don't have. I've been depressed for seven bloody years! It's clear to me that this isn't random, because every single time I've had a depressed "episode", it's been because I didn't understand some aspect of the world around me; the outcome didn't match my intentions or actions, or the behaviour of others didn't make logical sense to me or fit into my "unreasonably" high moral standards. I don't need medication. I need instruction. And I need it soon.

I'm not really qualified to respond, but I know that a lot of medications have unwanted side effects and, frankly, aren't that good for you. So if I was you, I would go with my gut feeling and seek a second or even third opinion before accepting the bipolar medication. Maybe ask around semi-locally and find out if there's a doctor within traveling distance who is more knowledgeable about Asperger's/ADD?

I was sent to see a speech and language therapist, that spent the session doing brief solution focused therapy with me. She gave me the impression that this was because there was nothing local they could send me to.

I think they are trying to save £ and this could be what has happened to you too?

All very well, but I wanted an assessment for autism spectrum disorder.

I have gone back to my surgery and demanded to be referred to someone competent, and that this has been a waste of time.

Of course, the receptionist made excuses, and said that there isnt anywhere local/ no support etc.. ..... is there ANYWHERE in the UK where this doesn't happen ??! !!

If you look up the National Autistic Society's website it will show you where the nearest person qualified to assess you is - you could take it to your GP - and ask why you were not sent to their services. ( They show NHS places on their website ).

Having read about what goes on in France, I feel a bit relieved to be here, but not much further forward after months of waiting ....

All the best - hope you get a good response from them soon,

Thanks for your replies. I think I'll suspend my communication with the psychiatric team and ask my GP about Aspergers specifically. I'm sure that medication could be a beneficial route for people with bipolar disorder but, at this moment in time, I will not consider it until Aspergers can be ruled out and bipolar disorder can be confirmed. I think there's a fine line between being bipolar and just experiencing the increasingly obsolete phenomenon known as emotion.

I was in a similar position to you, with the psychiatrist determined to get me on mood stabilising drugs as he wouldn't accept I had a lifelong condition. It was impossible for me to proceed further through the NHS as this guy controlled access to all other referrals and services for Mental Health issues in my area. Even appeals to my GP were in vain as she did not have to authority to go over his head.

Eventually he did concede that I presented as atypical autism or PDD and this was included in his report to my GP, but without official confirmation I cannot have any further access to any kind of support services.

Nemorosa, that's just ridiculous. I really can't see the logic behind this; I was under the impression that Asperger syndrome was an officially recognised condition. Why would the doctors prevent you from getting the diagnosis and support you need? This is the goddamn United Kingdom, not some repressive, medieval society. The only explanation is that there are some sh***y doctors around. Have you tried contacting the autism society or anything?

Of course AS is recognised, he just didn't recognise it in me because in his words "you've demonstrated you care about your family". He's firmly convinced someone with genuine AS cannot know or express love, nor recognise their actions have an emotional impact on others. So, yup, there are indeed some ignorant, uninformed and uneducated professionals out there.

My efforts on this front are on hold at the moment pending other business, but yes the Autism society would be a good starting point.

Hi Vanis, okay, this guy seems like an idiot. In fact, I'd say he sounds like an effing idiot. You ask a follow-up question, and the rationale changes, in fact the rationale is ridiculous, that you wouldn't want to drive half an hour [?] [!] My guess would be that it's really just about this guy's 'authority' and when he's made a pronouncement, that's basically it. At least for that setting. You might use someone else to appeal on you behalf.

A general practitioner here in the states once told my Mom that depression can start off situational and become biochem. I've also read that anti-depressant medication is trial and error in a respectable sense. That medication like Zoloft or Cymbalta might work great for one patient and hardly do a thing for another. And that no doctor in the world can predict in advance, not the best neurologist at Harvard. It's just that human biochem is complicated and tends to be complicated for different people. So, the upshot is, here in the states, a person might as well go to a regular doctor like an internist or family practitioner. And typically, a particular medication is either going to work in a month or not.
Treating depression can be hit or miss (2009 article)
http://ftp.wrongplanet.net/postt163505.html

And so, the way the game is played and won is to be willing to go through a series of antidepressants for about a month each (less if side effects are unacceptable). And it might be the 5th medication that works, great. Nothing wrong with that. All the more reason not to be stuck with a medication that's inappropriate. (Also sometimes important to come down off medication in stages even if it doesn't seem to be working).

Please note: I AM NOT A DOCTOR. I'm just a guy who has read some on this stuff. I may have taken Prosac in 1989 at age 26 for OCD if the young psychiatrist I was seeing had not been so pig-headed about the whole thing. I also sometimes struggle with depression. Have not yet tried antidepressants, but am open to it. And personally, I probably will see an internist or family practitioner, although that is an individual choice.

I think those of us on the spectrum are more directly concerned with societal ethics. I know I am.

Last edited by AardvarkGoodSwimmer on 23 Jan 2012, 5:57 pm, edited 2 times in total.

Oh, I see. I guess that's an example of the "stigma" people often mention and the promotion of awareness that people are dedicating themselves to. I hadn't considered that those in the medical profession might not be well-informed.

And as to why a doctor would prevent someone from receiving the help and support they need, well I think that is down to professional pride and vanity; they want to be seen in charge, can't have any old person coming in off the street and telling them their business. This happens in all walks of life, not just the medical profession.

Welcome to the club. Some of them aren't. Someone here at WP was even told by a supposed mental health professional (cough, cough) that a person can't be on the Asperger's / Autism Spectrum if they've had even one friend in their life. Wow.

Do the mood diary. If you don't have Bipolar it will prove that. I did it too and I found a pattern of my 'episodes' which ruled out Bipolar disorder.

You can only choose to not take medication. If you think you have AS then yes Bipolar meds could be damaging. Most of us are very sensitive to any type of medication anyway.

Some doctors have their own view of what autism and Asperger's syndrome are. Some even don't believe in AS and ADD. Keep looking around for a psychiatrist or any qualified health official who will actually do an assessment with you.

I think you are quite right here. I would go a step further and say that this happens more amongst doctors than other professions, and I think this is so because of the way doctors are trained and the way they are treated so deferentially by their underlings and staffs. Another factor is no doubt the frustration of dealing with an endless flow of self-diagnosing, computer owning hypochondriacs (I happen to know one of those intimately).

But the net result is that doctors often seem to ignore and dismiss input from perfectly logical and well informed patients. Unfortunate, but a hazard of the trade I guess. When you deal with this, it's usually best to just find another doctor, preferably one you have researched and asked around about.

And yes, I would DEFINITELY seek another opinion (from your GP or whomever) before starting on bipolar meds. I have only taken psych drugs once (SSRIs) and they gave me absolutely horrific side effects. I decided at the time I would find any other way do deal with depression than that! I know they work for many people, but I do think pensieve is right - people with AS can have some pretty big overreactions to medications.

I had a similar experience with a doctor who told me that his practice involved prescribing medicine and, since there was no medicine for Asperger's, there was no need to even explore that avenue.

The primary way most doctors resolve medical/mental problems is to treat the symptoms. For psychological/neurological issues, this can be a real disservice to the patient. As a patient who is more interested in identifying and dealing with the source of my problems, I have long been frustrated with doctors.

ok. just my quick reaction on the original post:

What if you went to the doctor with the flu, and you were reasonably sure it was the flu, but hey, you know, he's the doctor, there is some small chance it could be something else.... but mostly you wanted the doc to say "Yes, it's the flu" so you could tell your job or school that you have a valid reason to stay home.... but the doctor said "well, it may be the flu but since there is no pill for the flu, I think I'm gonna write down on your record that you have malaria instead, because I have pills to give you for that"..... what would you do then?

which leads me to think at the very minimum that there's a miscommunication somewhere, and since it envolves mind-altering medication, you'd better be sure and do what you need to do to be comfortable and certain of what's going on before you proceed... even if it turns out you do have bi-polar, wouldn't you want to be darned sure that you understand all the ramifications of medicating that? JMO

Exactly. There is no medicine to prescribe. No "treatments." There's no money in the system for anyone for Aspies.