Doctors are sometimes dismissive of you when you have bipolar disorder. Believe me, this is true. Most of us have seen the “dismissive doctor” phenomenon firsthand. And not only are general practitioners often dismissive of bipolar patients but so are specialists and most everyone else in the medical profession (especially in the emergency department of a hospital). This isn’t all doctors, of course, many of us know great ones, but many of us also have also had legitimate medical concerns dismissed because of our bipolar disorder.
What Happens When a Doctors Dismisses a Bipolar Patient’s Concern?
It usually happens like this: The person with bipolar disorder develops a medical concern – often one that is completely separate from bipolar disorder or the associated medications. When the doctor comes into the room to discuss it he seems receptive. Then he picks up your chart and sees that you have bipolar disorder. That’s when he looks at you like you’re crazy and tries to get you out of there as soon as possible, typically while offering no help at all – after all, it’s all “in your head.”
Lest you think this is bleak, dire or inaccurate, let me assure you, many people with bipolar disorder have had this exact experience. It’s night and day being treated by someone who knows you have bipolar disorder and someone who doesn’t.
Why Do Doctors Dismiss Those with Bipolar Disorder?
The answer to this question is complicated. In the case of psychiatrists (yes, they do it too) and emergency room physicians, I suspect it’s because they see the worst of the worst of cases of sick people seeking help. They do see people who are trying to scam them for medications (usually pain medications [Doctors Blaming All Physical Pain on Bipolar Disorder]). They do see people who truly don’t know what’s going on due to psychosis. They do learn not to trust what a person with a serious mental illness says to them. It’s ridiculously unfair, but it’s something that just naturally occurs after enough negative interactions take place.
And I should mention that often the worst dismissive doctor experience is when you’ve attempted suicide and need help just to stay alive. Emergency room doctors tend to treat you like crap. They don’t consider you worthy of their help, I suspect, as you “did this to yourself.” Emergency room physicians typically don’t see suicide for what it is: the symptom of a very serious disease just like a heart attack is. (This is not to suggest that personal responsibility isn’t important, however.)
As for why other doctors dismiss bipolar patients, that one I’m not so sure about. Some would simply point to the cloud of “stigma” that exists around mental illnesses. Okay, I guess. But doctors are educated about bipolar disorder and other mental illnesses so if anyone were to have a more realistic view of mental illness, it should be them. For example, there are often medical students in my psychiatric appointments because my doctor is the head of the medical school here. They sit through my session as part of their psychiatric rotation. (Of course, older physicians may not have had this type of training.) But maybe there are other lessons in medical school about what to “watch out for” when dealing with one of those nasty bipolary-type people, I don’t know.
Fighting Not to Be Dismissed By a Doctor Because of Bipolar Disorder
Believe me, dismissive doctors are a real problem for those of us with bipolar disorder and we need to learn to fight back. This is a very hard thing to do, but we know (and everyone needs to know) that we deserve the same quality of care as everyone else.
So, here are a few tips if you have bipolar disorder and are dealing with a dismissive doctor:
- Stand up for yourself. State what you need. Don’t be shy. Don’t let the doctor intimidate you just because he’s wearing a shiny stethoscope and portends to be better than you. He’s not.
- Stay calm and collected. This is not always possible, but if you can, try to keep the interaction professional.
- Be open and honest about what is happening – say it all. Don’t clam up because he’s being an idiot. Say what you went there to say.
- Don’t leave until there’s a resolution. Don’t leave that office until some resolution is reached. Now, this might be a resolution to see someone else, and that’s okay, but don’t leave feeling like you’ve made no gains.
- Ask the doctor to explain. If your doctor is giving you crappy answers to your questions, ask him to explain his reasoning. If he can’t do that, something is wrong.
- Be forthright about your bipolar disorder. If the doctor starts treating you badly the moment he finds out about your diagnosis, confront him with that fact. Say, “I feel you are not listening to me, possibly because I have a mental illness. I need you to treat me like anyone else.” You deserve to be heard.
- See someone else. If none of the above result in anything useful, then demand to see another doctor (or get a referral to one).
And if all else fails, make a complaint about dismissive doctors. I know this is easier said than done but many find it to be tremendously empowering to do this. No matter what it results in, at least someone heard you. (And you can always write about your experience in a letter to the editor of a newspaper. That can help with your complaint, too.)
You really do have the right be treated with respect and dignity and receive the same quality of healthcare as anyone else. Don’t let anyone take that away from you.
Graphic by Xoneca (Own work based on: File:Fired_stamp.gif) [CC0], via Wikimedia Commons.
My run in with this type of doctor happened before I was diagnosed with Bipolar II, I was “merely” criplingly depressed at the time. I went to see the doctor for abnormal fatigue. We all know depression can have a fatigue component. But this was beyond fatigue. For a little over 3 years I had chalked it up to being a single mom in school full time for nursing and also taking care of my parents.
I explained to the doctor what I had been experiencing. He explained the connection of fatigue and depression (gee whiz, thanks Mr Doctor Man). He then went on to explain to me that psychiatry is quackery, and that if he brought in 10 psychiatrists I’d get 10 different diagnoses. So he ran some blood tests, but still told me it was all depression. Yes, I was confused too.
Test came back with mild vitamin D3 deficiency, so I was told to get a supplement. I was also told to get Omega 3 for cholesterol. I got flaxseed oil, it did wonders for my mood. But I digress.
So I was completely dissatisfied with the”care” I was given. I call the doctor’s office up a couple weeks later and ask for a different doctor. This one actually listened! He agreed that what I was feeling was abnormal, no matter my mental health status. He tested me for mono and it came back positive.
Turns out I had CHRONIC mono on top of depression. Thank you Universe!
He told me to ask my psychiatrist about adding Wellbutrin to help give me energy and to also work with my Lexapro so I might actually feel happy.
It didn’t give me energy (I’m also ADHD, but was not medicated for it at the time), but my mood greatly improved.
I just got my Bipolar II diagnosis 3 weeks ago thanks to my new doctor telling me I needed to see my psychiatrist ASAP about my uncontrolled mood symptoms I described to her. It’s so refreshing to have someone who takes mental health seriously and puts real effort into helping you manage that aspect of your wellness. When I came back to see her she wasn’t at all phased by my diagnosis and spoke with me about my new medication and how I felt about the diagnosis. It was like a Christmas Miracle in July.
Where can I find the entry from stevie nicks on her being bi-polar ?
Hi Rhonda,
Sorry, I’m not sure what you mean. Stevie has been commenting here for years.
– Natasha Tracy
I’ve gotten this with chronic pain conditions (everything is related to that condition apparently) I have had my feet swell so badly I can’t put shoes on since I started a certain med in my twenties, I have NEVER experienced before in my life… because apparently it’s NOT a side effect of medications to most docs even if it’s listed on the medication pamphlet- it’s a rare side effect which I apparently get a lot of the rare ones when trying meds.
I’ve gotten this with bipolar too! Apparently the fact that when I am manic and my pain goes away means I don’t have chronic pain, it’s just a depression thing! (No, I still am in pain when manic I am just too distracted to give a fuck lol)
I just can’t win. Most times I go to my psychiatrist in regards to all health matters, not just mental ones. She is the best doctor I have encountered to date. She listens to my concerns and takes me seriously, will order tests to investigate my issues if she doesn’t know. She is the only doc in over 8 years to investigate WHY my feet swell. We have discovered it might be due to low potassium… (but not low enough that it’s hypokalemia) now we gotta find out why I have low potassium. My psychiatrist encourages me to see my GP about it since now there is a paper trail by another doctor, but I am too nervous to go and waste my time (4 hrs out of my day because I bus) only to be told “everything is ok” or to be dismissed in any other way.
It’s incredibly frustrating. Very defeating. So I just deal with my swollen feet by not doing anything. Great.
don’t get me started on the shabby quality of 21st century american healthcare… too late, i’m started. i grew up as a doctor’s son, which i guess is like growing up gotti, his kids probably got the finest in organized crime services, i certainly did when it came to doctoring. not a particularly astute child, i believed this was just how health care worked — a nurse would graciously usher me into the exam room the moment i arrived, the doctor would fawn over my every symptom and concern, the bill of course would be waived. imagine my shock as a young adult, especially dealing with psychiatrists… what a sad bunch of losers, misfits, control freaks, sadists and headcases. it’s rare indeed to meet a psychiatrist, or even a real doctor, who has any knowledge or interest in science. instead it’s a money game… the young ones are staring down the barrel of a $1m student debt, praying to dear god to some day make mid-six figures like their obviously burned-out senior colleagues; the old ones, well, they survived somehow, making a living in the lowest-prestige specialty, no longer caring that doctors regard them as embarrassments, men and women shunted into a medieval specialty because they’re either afraid of blood or too dumb to read a set of lab results.
that said, having said all that, i must say that every once in a while you meet a true saint, a highly competent caregiver who chooses psychiatry because s/he actually cares about people, brains, lives. these people understand how an ssri works, and they don’t amuse themselves by pulling wings off flies. there’s no explanation for why talented human beings end up in psychiatry… lord knows, if they cared about money, they be doing cardiology in houston.
Now you got ME started, michael. Between myself, one son, one DIL, and numerous hospitalizations for all of us, I’ve had to deal with 40-50 PDocs in the last 29 years. As an RN, I have had to deal with more of them and their co-hort psychologists than I can remember during a 40+ year career. I can count the good ones on one hand…and by good – I simply mean competent. That shouldn’t be a high bar – yet it is. One of my former brother-in laws is also a PDoc/screwball who was indeed afraid of blood & guts in med school & throughout his internship…not to mention the “thing’ he had for young girls – and I know for sure, because I was one of them back then. Yet, he wanted that doctor title before his name…so he went into psychiatry with his incognizance and disinterest…
My veins are a dream, thus I’ve always let new phlebotomists draw on me, and let RN’s who need more practice at starting IV’s use me at times. Easy-peasy as I instructed them. Last year, I had a surgical procedure at a teaching hospital. An intern, in the last month of her internship, i.e. one month shy of officially becoming an MD, tried to start my IV and failed. Although two tries is the general rule of thumb, or three with a very receptive patient, I encouraged her to try four times to no avail, even while coaching her the whole time. I’m very patient and a good instructor, and I have high tolerance for physical pain – that’s nothing for me. Although the intern said she’d started many IV’s during her internship, I knew she hadn’t done so with any success – you just can’t fake things like that.
So, guess where that intern was headed for her residency? Yup, psychiatry, though she showed absolutely no interest in it, not even after looking at my chart with my Dx of Bipolar1 with episodic manic psychosis. She didn’t really know what psychosis was yet, she said, nor mania – nor did she know the first thing about neuroscience…what an amygdala or a hippocampus was, not that she was interested anyway…but more importantly, she was very pretty and her fingernails looked great! Nine years of pre-med, med school and an internship combined – all that science for naught, and yet, I’m sure she’ll be “practicing” psychiatry within a couple of years – her “chosen” profession by default…like almost ALL the others, including my current PDoc, Dr. Clueless, I silently think of him, or a pretty, spoiled rich boy who likes the title Dr. in front of his name.
Yes, occasionally an exceptional PDoc is found, one who is passionate and updated about his/her field. I’ve only known two, and was fortunate enough to have one of them for a decade – my son got to have him for about six years. Then he retired…and then he died – he was a rarity and a warrior of a man – I miss him still.
I could tell you tale after tale, but you already know them all, michael. Yes, it’s true. Most have been “shunted into a medieval specialty because they’re either afraid of blood or too dumb to read a set of lab results.’ Often both, I’ve sadly learned, and I will add more: These are NOT my own theories; these are some actual quotes (or as close as I can remember them) from some PDocs and Clinical Psychologists I used to consult with during my nursing career – none of them knowing I had BP1 Disorder: Ah, the things you hear at a nursing station…
“I couldn’t stop at G.P. because I couldn’t hack being a doctor at all…I can’t stand being around sick people.”
“My student loans stopped me from leaving medicine altogether like I really wanted to, so I became a psychiatrist.”
“My parents would kill me if I didn’t come out with the title ‘doctor’ after all they’d spent on me…so I went into psychiatry/psychology.”
“$200K is better than $100K in some other job.” (I think I was earning c. $30,000 at that time as a F/T RN.)
and then there was this doozie I will never forget…
“I really like psychiatry because there’s no accountability. No one cares about psych patients, and no other doctors really know what we are talking about or doing anyway.”
Statements like that last one really fire up my neurocircuits – not that many PDocs understand what I just said.
I have a strong opinion about what needs to be done, if only there was such a thing as real advocacy for SMI…there isn’t, but I’ll save that for another post.
Suffice it to say that psychiatry should be relegated to the dustbin of history – it needs to go the way of 8-track tapes. This is about neuroscience and we need to be treated by neurologists like all the other brain-based illnesses are. That will not happen in my lifetime which is nearing the finish line, probably in the next decade or so…sadly, I fear, it wont even happen in my my son’s lifetime – and he’s only in his mid-late 30’s.
I’m sure you know that old joke, michael: What do you call a doctor who finished last in his medical class?
Answer: Doctor.
That’s only partly true – they are more aptly called Psychiatrists, I’ve learned.
At some point, I may post more about the very real harm the “so-called” psychiatry profession has caused us. Not just the meds, the mis-diagnoses and delayed Dx, the way they cling to their witch-doctor practices, their control freakdom over their kingdom. It goes way deeper than that…but not today.
Thank you, michael, for inspiring me to post this.
And Thank You, Natasha, for the wonderful things you do to provide us with this forum to express our thoughts and feelings. There’s hardly anyone but ourselves who are even willing to listen. Keep up the good fight and stay well – that goes for all of us!
Dear Natasha,
Great article. Prompted me to purchase your book. Yeah!!!
I’m pickier about my Doctors than they are regarding whether or not they want me in their practice. I do everything I can to be low maintenance. I’m never in a hurry, I’m on time for my appointments, I bring my newspaper, wear a walkman and bring food in case I’m there all day…and I’m reliable with my meds. I don’t miss taking them and I don’t run out early. A doctor’s office is stressful enough, I don’t need to add to it. If I’m not careful, I do stress doctors out. Because of bipolar disorder partly, but more because, after 30 years on bipolar meds, they see their own fallibility, they witness the results of “Too Much Medicine.” Frankly, I’m a pharmaceutical scrap heap, even though I’m healthy, athletic and vibrant, maybe too much so. I keep all my medical records. I also keep track of who seems interested in helping me and who ….not so much.
I’ve had 2 orthopedic surgeries go sideways due to physician negligence, allergic reactions, Tardive Dyskinesia, Prozac Poopout….the list goes on and on. But gosh, do I have a GREAT treatment team. I assembled them with great care. It took time but was so worth it. But then maybe I have it in hand because I’m on disability by now, on Medicare and can basically see any Doctor I want if I can cover the remaining 20% Medicare doesn’t cover.
I used to REALLY annoy doctors because I’m a former child champion of latin-greek word roots and a medical transcriptionist. Apparently, they don’t like it when someone who is not a doctor speaks their language with fluence and ease. I was told by my neurologist to dumb it down so as not to seem arrogant, so I did.
I’ve learned not to mention my past history of substance abuse from the 1970’s, because some doctors do not want anyone in their practice with those issues. They all know I have bipolar disorder, and they ask me to give them advice on whether they should prescribe Latuda or Abilify….which drug causes more Tardive Dyskinesia …that sort of thing. They also ask my advice on how I’ve kept my weight down and kept from getting diabetes, since 30 percent of the people on Clozaril get type two diabetes in their first year, and I’ve been on it for 11.
Well, anyway, you can see, I have a complicated profile and bipolar is just the half of it. At 57, I’m grateful I still live independently, instead of an ALF, where lots of my peers live, and that I’m avoided the psych ward for the past 21 years…not that I wouldn’t go if I needed to, but I think, at this point, if I went in hospital for mania or depression, I actually know my situation better than a recent med school graduate whose had all of ten minutes to scrutinize me.
Ten minutes in the hands of an amateur could cost me ten years…or my life. No thanks.
TRUTH!
I’m 65 and bi-polar since my early 20’s. Your article has helped me and I’m just new today. Thank you Sincerely rhonda
Medical people (not only doctors) definitely have a much higher rate of stigma than you would expect. Especially to doctors with mental illness (one very large contributing factor in the very high rate of physician suicide). Some are just ignorant jackasses, some I think just get worn down by what they see and become jaded. I think some of the negative behaviours associated with borderline or other personality disorders then get extrapolated to everyone with mental health issues.
If as a result of having mental illness you have less emotional resiliency, you’re also more likely to react poorly to another message of “there’s nothing wrong with you.” That will also stick out in the medical person’s head. I know someone with bipolar who went through many rounds of the disrespect and frustration with a whole range of doctors until they finally saw someone who correctly made the (not common but perfect fit) diagnosis that explained her pain and all other symptoms (victory!!!)
Oh, and I learned just this week that the pattern where physical illnesses are attributed to mental illnesses ‘just because’ is called “diagnostic overshadowing” a term originally used with people with developmental disabilities. ?
You are on point. Sad but true. Great Advice!
Best, Cookie
Hi Natasha, great to read your blog. It’s important to keep trying to undermine the stigma around mental illness for all our sakes!
Here is a link to my article on stigma which you might like to read. https://www.amandarobinspsychotherapy.com.au/articles/2017/8/2/the-long-journey-back-stigma-and-mental-illness
I don’t get confrontational in any way with doctors that seem to be discriminatory, I just don’t go back if it is clear or becomes clear that the care will be substandard. If they already have a “headcase” opinion, I don’t want to feed it, because they can write a lot of things in their records, and I don’t care about their medical opinion.
That being said, I’ve only run into one doctor that was like that, and one spectacularly rude er nurse after a car accident. I was too concussed to remember, but my husband said that she was very derogatory about my suicide attempt years earlier, which I’d been hopitalized there for, and insinuated that I’d done it on purpose within hearing range of the door.
I see this with my bipolar, and my son’s migraines. Either “he’s too young to be this bad” or “Since you are bipolar, his symptoms have to be because of mental illness and/or the stress of living with a mentally ill mother”. We have a wonderful nurse practitioner. And specialist. But we have been treated so bad at the ER that I call “the good ER doctors” wife to see when he’ll be in (they go to our church) if I can’t get ahold of J’s neurologist before I bring him to the ER. Otherwise it’s a waste of time and money
I have heard about this issue, but fortunately never really experienced this with doctors. I won’t say that some doctors didn’t get a bit frustrated with my bipolar symptoms and react poorly, but actually that was just one.
My GP is a very good one. He is the person that referred me to the psychiatrist that first diagnosed me with bipolar disorder about 15 years ago. Sometimes I go to my GP for symptoms that end up being symptoms of anxiety and not anything else. He doesn’t just dismiss them. He checks what needs to be checked to ensure that anxiety is in fact the likely source, i.e. listens to my heart, has given me an EEG, maybe orders blood tests, listens carefully to my story and asks questions. he’s given advice for anxiety symptoms. Some my psychiatrist and therapist didn’t even give me. Perhaps because his father is a psychiatrist it helps.
All of the doctors in the ER seemed to treat me appropriately. The only doctor I had that seemed dismissive was a neurologist. Once I broke down in her office, and her reaction was quite inappropriate. She was almost yelling at me to stop crying. Some of the things I went to her about she just said were “psychiatric-based”. Often my psychiatrist thinks some things are medical when in fact they turned out to really be psychiatric-based. But my psychiatrist wasn’t dismissive. He was more overly cautious and diagnosing stuff he shouldn’t have been. He’s thought some anxiety symptoms were things like ulcers. He thought dissociative symptoms were seizure activity. I still like him anyway.
When I first saw the title of this post I had something different pop in my mind. It was more about how I’ve had therapists (not psychiatrists or other doctors) literally dismiss me or pass me off to other therapists because my bipolar 1 disorder was too much for them. I’ve had a therapist that called my psychiatrist saying she was scared of me (and then basically got rid of me). I’ve had therapists in IOPs not want to handle my severe case. I’ve had others respond to my mania with extreme anger. This has actually been more of an issue for me than the actual topic of this post. I have to confess that when I’ve needed to find a new therapist, I am reluctant to tell them I have bipolar type 1. I’ve even had therapists tell me I worried them by some of my stories of past manias. This was especially the case with female therapists. Sorry if that sounds sexist. It’s actually the case. I am a female myself. I imagine this can also be an issue for male patients with female therapists.