Doctors often don’t listen to people with bipolar disorder or other mental illnesses. In fact, most people with bipolar disorder know, the instant a doctor sees “bipolar disorder” on your chart, you’re screwed. Now, don’t get me wrong, not every doctor is the same, and I have had some doctors treat me with the same care I suspect they would offer anyone else. That said, on the whole, doctors don’t listen to people with bipolar disorder. Here’s why, and here’s how to fight it.
How Doctors Don’t Listen to People with Bipolar Disorder
If a person with bipolar disorder goes to the doctor with pain and the doctor sees “bipolar” on their chart, the doctor tends to think one of two things: either the pain is psychosomatic, in which case the doctor doesn’t care about it, after all, the person is “crazy,” or the person is drug-seeking, in which case the doctor wants to get rid of the patient as soon as possible. Both of those scenarios end with the person with bipolar disorder leaving their appointment without help for what could be very real pain from a very real and possibly harmful condition.
If a person with bipolar disorder goes to the doctor with concerns over unusual symptoms, say, unexplained gastrointestinal problems, again, the doctor likely thinks one of two things with bipolar: either the symptoms are psychosomatic, or the symptoms are side effects. In both cases, they are “not their problem” if they are not the prescribing physician.
Oddly, doctors don’t even believe people with bipolar disorder about mental illness symptoms. For example, a person can be acutely, horrendously, agonizingly suicidal, and they won’t get admitted to the hospital because doctors don’t actually believe the person will do it, and beds are so scarce and insurance so difficult to navigate. How’s that for ironic? In other medical scenarios, the person is “too crazy” to listen to, but when it comes to getting help, the person isn’t “crazy” enough.
And on and on and on. It’s really no wonder that people with mental illness often have difficult and acrimonious relationships with health care providers.
Why Don’t Doctors Listen to People with Bipolar Disorder?
Of course, only a doctor can definitively answer this question, but I suspect it’s many reasons.
- Bad past experiences — Doctors, especially in the Emergency Room, see the worst of the worst cases of bipolar disorder where people may not be telling the truth or, indeed, even know what they’re saying. They carry this prejudice over to the rest of us.
- People with bipolar are often addicts — There’s a reason doctors worry about drug-seeking and bipolar disorder — more than half of people with bipolar disorder have substance abuse issues over the course of their lifetime.1 Of course, that doesn’t mean we all do.
- People with bipolar disorder may not know what they’re saying or feeling — In an acute bipolar mood, people with bipolar disorder are often so sick that they’re not rational, and, indeed, some are even psychotic. This doesn’t mean they shouldn’t be listened to, however. In fact, I would argue it’s even more critical to listen to them at that point and get them help.
- People with bipolar commonly have am anxiety disorder — Almost half of all people with bipolar disorder will also have an anxiety disorder at some point in their lives.2 This means that hypochondria is a real possibility, and so are psychosomatic symptoms. Again, this doesn’t mean that people shouldn’t be listened to, however. Suffering is suffering, and suffering from anxiety is just as important to treat. (Although due to concerns about drug-seeking, people in an acute anxiety state might not even be able to get a prescription for most anxiolytic medications.) Untreated anxiety does worsen the prognosis of bipolar disorder, after all.
- Plain prejudice — Yup, mental illness stigma can affect doctors too, and this can result in prejudice and discrimination against those with bipolar disorder. I suspect doctors think they are above that, but they certainly are not.
How to Fight Doctors Not Listening to People with Bipolar Disorder
First off, I think it’s critical to understand that the worst experiences tend to come from doctors with whom you have no relationship. They have no basis on which to really judge your behavior, and thus, you may get the short end of the stick. People are most likely to discriminate against those they don’t know. This means that developing a relationship with one or more doctors is critical and seeing those doctors for any concern you may have is also important. Of course, this isn’t always possible for a variety of reasons, but I think this should be the number one priority if you can do it.
Some people say not to tell doctors you have bipolar disorder, and I understand this idea. In fact, if I had to go to the Emergency Room for a migraine tomorrow, I would consider doing this. However, many times, if not most times, your bipolar disorder can interact either with the condition for which you are seeking help or with the treatment you may be prescribed, so hiding it is really at your own peril. I don’t suggest it. I particularly don’t suggest it when it means you have to outright lie. This will destroy any trust you may be able to develop if they find out (which is fairly likely in many scenarios).
But if you have to see a doctor that you don’t know (or in some cases even if you do know the doctor), bring someone with you who can advocate for you. Nothing is worse than being alone and trying to justify why you are getting medical help to a doctor that isn’t listening. Bringing a person without the dreaded “bipolar” stamped across their forehead gives the doctor someone to listen to that they may be less prejudiced against. Basically, the two of you can team up on the doctor, and you’ll likely find additional strength just having the support there.
Finally, I recommend trying to be as calm as unemotional as possible if you have to deal with a doctor. I know this is kind of a ridiculous suggestion due to what might have led you to get help, and it’s unfair to ask someone who needs help to act in a certain way to counteract the unfairness of doctors, but that’s the world in which we live. Honestly, the calmer and more rational you can appear, the more likely it is a doctor will treat you as if you’re not “crazy.”
Remember, Some Doctors Will Listen to You
Despite all of this, it’s important to remember that not all doctors are the same, and some will listen to you and treat you with the same care and respect as any other patient, so it’s important for us not to be prejudiced against them. If you go into a medical situation expecting a negative interaction, you may just create that reality.
So, it’s okay to be very conscious of any interaction you have with a doctor, but also know they can be our best resource and way of getting better. It’s a tricky relationship to navigate, no doubt, but it’s something we must do to obtain and maintain health.
Sources
- Cassidy, F. et al., “Substance Abuse in Bipolar Disorder.” Bipolar Disorders, Aug. 2001.
- Pavlova, B., et al., “Lifetime Prevalence of Anxiety Disorders in People with Bipolar Disorder: A Systematic Review and Meta-analysis.” The Lancet. Psychiatry, June 2015.
Thanks for sharing such an article. Bipolar disorder is a disease in which a patient can’t do the right things which are the most dangerous situations in this patient is dealing with two kind of situations. For these types of people, I prefer they contact some good therapist who is providing mental health services so that they can get rid of their mental health issues.
I resonated with this article. It’s like once a doctor finds out you have bipolar disorder, everything you claim is wrong is “all in your head”. It’s frustrating and disheartening.
My primary physician says that I need to lose 50 lbs. I need to improve diet and exercise. Well, duh! I know all this. I’m not stupid.
When I get depressed it’s hard for me to get out bed.
I tell him I have been trying, but it’s not easy.
He tells me that I can do it. Just get up and do it! I am sick and tired of excuses!
(We if you’re sick AND tired. doc? Get some rest and heal thyself!!)
I come out of his office feeling like crap and start believing him. Maybe I am using it as an excuse. Even though I know better in my mind. I doubt it in the way I feel.
I felt worse after seeing the doctor than I did before I went in! Now , what is wrong with that picture?!!
I’m seeking a new primary physician.
“Here’s why, and here’s how to fight it.” (taken from the last line of your first paragraph..)
For me, here’s why (doctors don’t listen to me): Because they listen to my control freak of a mother, instead. That bitch ruined my life!!!
And here’s how to fight it, really? What an oxymoron to expect a person with depression to fight anything!
I have bipolar 2. I am also a retired psychiatrist. Unfortunately, many physicians don’t listen to ANYONE. The typical physician slides through 2 months of psychiatry in medical school, and never thinks about the subject again. Good basic techniques like reflective listening (“I hear you say that your main problem is insomnia”), that actually SAVE physicians time and going down rabbit holes, aren’t used. Partly this is because medical care has been industrialized, as if it were an Amazon order.
I was NEVER in private practice, so I had the luxury of sitting with patients as long as they needed to be seen, in settings like a community mental health center, and at a VA. I was also fortunate that I graduated from a state medical school in 1980, and the tuition was low enough that I never had any loans.
My advice is that if you find ANY physician who actually listens, to treat that person as a gem, and ask for referrals from that person, because good physicians tend to identify other good physicians. (I had an excellent encounter with a neurologist, and got a referral to primary care through him.)
Thanks for this (and especially appreciate you included last section). I suspect bipolar is probably second only to borderline personality disorder for this kind of conduct and diagnostic overshadowing. At meta level, the power differential and lack of accountability/recourse/consequences means this is unlikely to change. Your immensely practical and wise advice is sadly necessary.