She is my psychiatrist. She told me she is bi-polar. Now what?
January 15, 2014 1:58 AM   Subscribe

How did you react when your psychiatrist disclosed their own mental illness to you during a session? Have any other mefites had this experience or heard of it? During my 4th consultation (over 6 weeks) with a psychiatrist who is treating me she sort of casually disclosed that she herself suffers from bi-polar disorder and that she has in fact been hospitalised 3 times in the last 12 months due to it.

I don't know a lot about bi-polar disorder, and its definitely not my affliction. It came up in the context of me talking about how I feel that I have achieved less than my contemporary peers in my career and not fulfilled my potential in my work/life, and this is true, in part due to my illnesses. She prefaced her disclosure with something along the lines of "I shouldn't tell you this because you'll never come back, but...". It was like she was trying to empathize with me, not a formal declaration or warning or caveat.

I was surprised, and I told her I was but that I empathize with people who have mental illness, and try not to stigmatize them. To which she immediately responded "But evil_esto, you DO stigmatize yourself, don't you?" And then we were back to talking about me.

Cycling from the clinic back to my house it hit home what she had disclosed to me was unusual. One friend of mine said in a message "Whoa! Thats brave of her to share".

I have been dealing with some mental illness most of my life, and I have seen numerous psychiatrists, psychologists, counsellors etc on and off since the age of 16. This Doctor is new to me and so far I have felt that it is a positive thing for me to be doing and I am seeing some (albeit slight) benefit. I intend to continue seeing this Doctor and have 2 more appointments scheduled this month.

Would you continue to see a psychiatrist who disclosed that they had mental illness to you?

A few things I thought were:

1. Well, you could have cancer and your oncologist could have cancer too. Would that mean you "fire" them and go somewhere else?

2. I've watched all 3 seasons of Homeland and Carrie Matheson was the 'only one who was right'! :)

3. Surely, if she was too ill to practice competently her peers would prevent it? There must be some guidelines or professional code of conduct that covers this sort of thing, right? (I'm in Australia and my doctor is a MBBS FRANZCP. I go to a well known and long established private mental health clinic attached to a small private mental hospital. I was referred by a public hospital psychiatrist because I had pretty good private cover).

I found this but it wasn't very illuminating.

I welcome your thoughts whether you have reasons to seek psychiatric treatment yourself or not. Mefimail me if you would rather not reply here.

posted by evil_esto to Health & Fitness (39 answers total) 4 users marked this as a favorite
I would. It would make me admire them more, and feel that they can indeed relate to me.
posted by dubious_dude at 2:26 AM on January 15, 2014 [9 favorites]

I agree with dubious_dude. I would continue seeing her for those reasons as well. I have a friend who is bipolar, and who regularly checks into the hospital when she needs to. I consider her very responsible, and she's a wise, intelligent person to boot, and good at her job. Your therapist sounds like a great example of someone living well with bipolar disorder.
posted by Rainflower at 2:32 AM on January 15, 2014 [1 favorite]

I dabbled a little bit with therapy in my mid 20's, and saw 5 different mental health professionals in a short period of time before deciding it wasn't for me. None of them told me that they were mentally ill, but I've known a lot of mentally ill people over the years, and 4 of these 5 therapists reminded me more of the mentally ill folks I've known than the 'sane' ones. I got the impression that many of the people who get involved with psychology do so because they themselves have psychological problems, and they want to understand them better, and want to help those who are going through the same things they are.

If this situation is working for you then I'd say to continue seeing her. However, in my own situation I felt like it was one case after another of the blind leading the blind, and that was a part of why I decided to stop pursuing therapy.
posted by sam_harms at 2:56 AM on January 15, 2014 [5 favorites]

If your psychiatrist is effective in helping you and isn't showing any erratic behaviours, I wouldn't worry about it.
posted by orange swan at 3:05 AM on January 15, 2014 [8 favorites]

"Would you continue to see a psychiatrist who disclosed that they had mental illness to you?"

Anyone with a mental illness who could get through the rigours of becoming a psychiatrist - I would see it as being a plus in their favour.

Marsha Linehan recently disclosed her mental illness.

An interesting question to pose to your dr could be if they would see themself - ie who would they get treatment from, if they had the choice?

I've had a counsellor mention they've had therapy - but it didn't make any difference to me.
posted by gusset at 3:07 AM on January 15, 2014 [5 favorites]

If you think about the sort of person who would pursue therapy as a career, a fairly significant percentage of them will have been through therapy themselves.
posted by empath at 3:13 AM on January 15, 2014 [3 favorites]

I just want to point out, my Psychiatrist is a Medical Doctor who has chosen to specialise in Psychiatry. She is not a 'psycho-therapist' per se. Or a 'Psychologist'. She went to Med school, got her degree and then chose Psychiatry as a specialisation; another 3 or 4 years I believe.

I understand that a lot of people drawn to the psychological field are 'natives'. In the same way a lot of Anaesthesiologists and Pain doctors are susceptible to drug addiction.

I have considered and I'm sceptical about the whole "Physician: Heal Thyself" thing. Hence, my question(s).

Thanks everyone so far. I would like to read more.
posted by evil_esto at 3:26 AM on January 15, 2014

Psychiatrists have supervision themselves. Like psychologists in Australia too. It's not responsible to listen to problems all day and not offload to a qualified colleague regularly. I wouldn't be worried at all. She's under close professional supervision as well as supported by the clinic staff. A private mental health clinic is not going to have a dodgy doctor potentially sully their reputation and lose them business.

I've worked at a few private psych hospitals and clinics in Australia and I wouldn't worry more about her than any other health professional. Just observe your own boundaries and stay you always should. And yay you for getting help. Hope it continues to improve.
posted by taff at 3:34 AM on January 15, 2014 [3 favorites]

Years ago I had a CBT (not doctor) who about her bipolar disorder. She was probably the best therapist I had - although sometimes she would tend to talk about herself a bit - especially if she seemed to be stressed out. I learned a lot from her. I was seeing her for panic disorder/social anxiety. She ended up abruptly moving across the state, though.

My reaction to her disclosure wasn't total surprise. I kinda felt more comfortable.
I have had two neurologists with neurological conditions as well.
posted by KogeLiz at 3:39 AM on January 15, 2014 [3 favorites]

I am currently seeing someone for CBT and have found myself put off by her personal disclosures. They seem to cross the line between establishing rapport and "bonding." In my case I'm starting to edit myself when talking to her, but in your case your doctor used her revelation to give you more insight into your experience - to support your treatment.

If you are otherwise satisfied with your medical care, stay with her as long as she is being treated and as long as her condition isn't impinging on her ability to treat you for yours. But keep an eye out for oversharing - you're her patient, not her therapist or friend.
posted by headnsouth at 4:38 AM on January 15, 2014 [8 favorites]

When I read the part of the question on the front page I thought you were going to describe a psychiatrist with very bad boundaries. Your interior extension made it clear that this woman was using a bonafide therapeutic technique (therapeutic use of self) to make an intervention into how you see yourself.

I would be concerned about seeing someone with bad boundaries, I would not be concerned about seeing someone with Bipolar disorder per se. However, this doctor's bipolar disorder is not at all controlled. Being hospitalized three times in one year indicates very unstable disease, especially if it isn't within the first year of diagnosis. I would be concerned about that.

Psychiatrists have supervision themselves.

Perhaps, but this is by no means a guarantee. Certainly in the US, post-training, it is very unusual for psychiatrists in general practice to be supervised in any meaningful way. I haven't been able to find anything that indicates that this is different in Australia.

Surely, if she was too ill to practice competently her peers would prevent it? There must be some guidelines or professional code of conduct that covers this sort of thing, right?

I would not be too sure about this. In my experience, and I have some experience with this, in the US Boards of Medicine and other doctors are very lenient with colleagues.
posted by OmieWise at 4:53 AM on January 15, 2014 [6 favorites]

I would have no problem seeing a psychiatrist or therapist who had a mental illness. I think that might actually be really great - it might be nice to have a sense that my doctor had been through some of what I go through.

That said, any one particular doctor with a mental illness could be bad at boundaries, or too unreliable, or I might not like the person who fills in if he/she has hospitalized, or any number of things. I think in your situation I'd stick with her for at least a little while, see how it goes, see if you feel comfortable and continue to see benefit, and take it from there.
posted by Stacey at 5:03 AM on January 15, 2014 [2 favorites]

Yes, I had a counselor that disclosed his bipolar disorder to me. He was the best counselor I ever had.

It's an individual thing but it really does have to be the potential to be a great feature and not a bug.
posted by St. Alia of the Bunnies at 5:28 AM on January 15, 2014 [3 favorites]

(There are a LOT of undisclosed bipolar individuals in very responsible jobs. Really!)
posted by St. Alia of the Bunnies at 5:29 AM on January 15, 2014 [7 favorites]

I would not generally be concerned about having a psychiatrist who was diagnosed with bipolar disorder.

I would however be concerned about having a psychiatrist who had been hospitalized 3 times in the previous 12 months for their bipolar disorder, because it indicates the possibility of future episodes of unreliability or unavailability.
posted by alms at 5:55 AM on January 15, 2014 [12 favorites]

I have an acquaintance who's a professor of psychiatry at a prestigious medical school/teaching hospital here in the US, and he has commented to me that the majority of his students becoming psychiatrists have psychiatric diagnoses themselves (most of them since before beginning med school). He said that, yeah, people get interested in the field because they have experience with mental illness and -- maybe more importantly -- were themselves helped enough by psychiatric care to make it through the rigors of a difficult college program and then med school, so they tend to be big believers in the therapeutic benefits of psychiatry.

In general I think it's no big deal and I think it's a pretty normal thing for a therapist to disclose, especially if you're talking about stigma. I personally would be a little worried that she'd been hospitalized 3 times in the last 12 months (not because of any deep insight into psychiatric hospitalization, just because psychiatric hospitals seem like a big deal), but then that does show that she's actively seeking and receiving care, and if she were functioning fine in my sessions, I probably wouldn't worry about it. My only real concern would be that she has a backup doctor to cover for her in case she was hospitalized when you had a crisis or needed a med refill or whatever, which it sounds like she is because you're at a clinic attached to a hospital, so it's not like she's a solo practitioner.
posted by Eyebrows McGee at 5:59 AM on January 15, 2014 [4 favorites]

I wouldn't have a problem with someone who is addressing their mental illness--to me that would increase confidence-- but I would want to make sure I was comfortable discussing and processing how I felt about the disclosure. And certainly, the potential of them not being available for whatever reason could be part of that discussion.
posted by BibiRose at 6:16 AM on January 15, 2014 [2 favorites]

I've been fairly open about the fact that I (have/had/am in recovery from) bulimia (I haven't purged in over 2 years). My therapist of 5 years who is a freaking goddess and basically saved my life also had an eating disorder which she is recovered from and is very honest about. I had a previous ED specialist that was probably not as recovered as she thought she was and I had to leave her, probably due to those issues.

Do what feels right to you.
posted by Sophie1 at 6:43 AM on January 15, 2014 [3 favorites]

Another angle:

I'm sure her very professional motive was to powerfully illustrate for you--someone who presented with internalized stigma and a sense of limitation by your diagnosis--that it was possible to be bipolar AND a respected, highly educated professional in a demanding field. She wanted to give you hope, and that's terrific and completely appropriate.

Not so terrific is the fact she disclosed she had been hospitalized three times in the past year--that would have that that new hope into new despair for me (oh god, you mean even a respected, highly educated professional in a demanding field--who seemingly would have the best access to care possible--hasn't been able to move past the point of disruptive medical emergencies with this diagnosis?). I would have wished she had left that part out. (Saying to a patient, "and I still struggle, so it's not just you," is not the same as saying, "and my symptoms are still so out of control that if I wasn't in a very elite health care job I'd probably be unemployed right now.")
posted by blue suede stockings at 7:23 AM on January 15, 2014 [3 favorites]

I personally would be a little worried that she'd been hospitalized 3 times in the last 12 months (not because of any deep insight into psychiatric hospitalization, just because psychiatric hospitals seem like a big deal), but then that does show that she's actively seeking and receiving care

This is, again, not necessarily true. Being in the hospital is not always something that people choose for themselves, and even if it is, it can easily mean that they made poor choices regarding treatment and attention to their disorder prior to hospitalization.

To be clear: sometimes Bipolar Disorder is tough to treat and tough to get a handle on. Sometimes the absolute best efforts of patients and their treatment team do not lead to a controlled disorder. However, and I say this with a lot of specific micro- and macro-level knowledge, it very often means that someone is not making a good faith effort to do what they need to do to control their disorder. Either way, in the mental health system I work in (at the macro level) we consider someone with three or more hospitalizations in 12 months to be someone with an out-of-control disorder in need of substantial and immediate treatment changes. (Which is, again, not a comment on them as people or the amount of effort they are putting in to their treatment.)
posted by OmieWise at 8:09 AM on January 15, 2014 [3 favorites]

(oh god, you mean even a respected, highly educated professional in a demanding field--who seemingly would have the best access to care possible--hasn't been able to move past the point of disruptive medical emergencies with this diagnosis?)

This could also be presented as, "You mean even a respected, highly educated professional in a demanding field has mental health issues?" Because yes, doctors are people too, and people have problems. "Disruptive medical emergencies" happen, and sometimes the best we can hope for is to mitigate their effect. Perhaps without "the best access to care", this person would have been hospitalized more frequently and/or for longer periods, or not be able to practice medicine at all. Instead, she's taking care of her mental health as appropriate, just like someone with reduced kidney function might have to undergo dialysis periodically despite controlling sodium intake, monitoring activity level, etc.
posted by disconnect at 8:22 AM on January 15, 2014 [2 favorites]

Hi mental health professional here. I can see from the 'outside' that this looks like a positive/progressive or brave thing to do but my take is that it is unprofessional and unboundaried.. primarily because when I see someone I am there FOR THEM and not vice versa.. if they start thinking/worrying about me and my world than that goes off track. Yes I try to be warm and empathic in my work, and show a bit of my personality, but to an extent I'm also a 'blank canvas' for patients.. to not generate loads of confusing transference (when people start to unconsciously connect with you other/previous figures in their life).. this will happen anyway to some extent if a relationship develops.

Boundaries are really important to protect everyone in this work. There's certainly been times I've wondered if I felt worse than they did and a part of me would happily have turned the tables but I've never done it... and never would. Sometimes I will use the word "we" as in a common humanity..hand hopefully make someone feel less isolated "we might feel like x if y happens" etc.. but maybe that could get misconstrued. I'd second that there are a lot of wounded healers working in therapy or mental health discipline per se. Sometimes this can bring an empathy.. sometimes it can be too close or inappropriate (not all disorders are born "equal").

That said it also is a human (professional) relationship... and people who give a bit of themselves can be quite a human thing to do. Personally I'm uncomfortable with what she said to you, but bottom line is do you feel safe and comfortable with her? It seems so. That's pretty much always the most important thing.. you used the word 'unusual' nothing 'more' than that.
posted by tanktop at 8:45 AM on January 15, 2014 [4 favorites]

Instead, she's taking care of her mental health as appropriate,

Look, I'm only stressing this because it is germane to the question asked, but we have no idea, no idea at all, whether this is true.

Going to the hospital for any chronic condition does not always mean "taking care of her [X] as appropriate." Quite often the opposite is the case. Hospital care is sometimes unavoidable, but is also something that happens when someone is not taking care of themselves.

I used to have a roommate with Diabetes who did not take her blood sugar, did not use her insulin appropriately, and ate whatever she wanted. She ended up in a couple of scary situations and one diabetic coma because of this, for which she was treated at the hospital. I assure you that she was not in the hospital just because she had DM, she was in the hospital because she hadn't taken care of her health as appropriate and we had to call an ambulance. This, of course, did not make her a bad person, but hospital care per se is not dispositive as to whether she is taking care of herself.
posted by OmieWise at 8:54 AM on January 15, 2014 [2 favorites]

I think using her hospital stays as a judge of her wellness is a little punitive. You don't know what stressors (like a move or a divorce) she might have faced this year that when combined with her preexisting condition might have led to her being hospitalized. You also don't know if she's in the process of having her own meds adjusted after a hormonal change, pregnancy, or even major weight loss.

I think that if she's someone you trust and helps you be committed to attending your sessions she's good for you.
posted by spunweb at 9:12 AM on January 15, 2014 [2 favorites]

Reread my comments. My whole point is that we don't know why she was in the hospital. That is not a punitive stance. What we do know is that her illness is not well-controlled.
posted by OmieWise at 9:18 AM on January 15, 2014 [2 favorites]

wouldn't bother me in the least. i used to practice law, and once in awhile i would have legal problems of my own, necessitating my own attorneys, but that didn't affect my work product.
posted by bruce at 9:36 AM on January 15, 2014 [1 favorite]

my shrink disclosed her mental illnesses to me. it made me feel better because other shrinks had taken the "depression doesn't REALLY exist"/"you just like being depressed" stance with me. she KNEW what depression was and knew it was real, so i knew she would at least be taking me seriously.
posted by misanthropicsarah at 9:37 AM on January 15, 2014 [4 favorites]

As the person looking to the counselor for a blank slate, as said above, I would be concerned about the spell being broken. For me this wouldn't just apply to disclosure of a mental illness but something like when a therapist described having worked summers at Gap to pay his way through a Ph.D program.

Our trust seemed built on the illusion that he was just a little bit otherworldly, like an oracle or a Vulcan. But the way he described working a regular job, I could picture him as just another city resident like myself, earning a living, only doing so after having been promoted from the guy selling me khakis to the same person billing me for life advice. The suspension of disbelief was broken, even though he was a fine counselor. To me the disclosure of serious mental illness would do the same thing.
posted by steinsaltz at 10:28 AM on January 15, 2014 [2 favorites]

It sounds like she used a verifiable therapeutic technique to focus on you and your beliefs that people with bi-polar cannot be successful. However,

"I shouldn't tell you this because you'll never come back, but..."

That bothers me. 1) Continuity of care is important. Scaring away a patient is NOT the way to go about countering a belief. If she thought that you wouldn't come back, its not a techinque she should have used period. There are many many ways to focus on this, and she chose a method she thought you would disagree with.

2) It can be seen as a manipulative statement. By suggesting you would leave ( and reject her) It is putting responsibility in your court for accepting her disclosure, and putting more emphasis on her life. If you reject the disclosure - are you rejecting her mental illness? (I'm not saying you are, but it could be seen that way).

3) Obviously it has created a sense of worry and taken your focus OFF of your care and about HER life which wasn't the point of the technique at all.

I don't think this situation is a make or break it for seeing the person. Ultimately if it is working, and no other boundary issues happen, I wouldn't worry about it. However, if there are more red flags I would leave ASAP.

Bringing this topic up with her is appropriate as long as you focus on you and your feelings about the disclosure and its effectiveness. IF she talks about her, (aside from apologizing, or explaining her rational in a simple manner) leave.
posted by AlexiaSky at 10:49 AM on January 15, 2014 [3 favorites]

Frankly, I (dealing with anxiety and bipolar disorders) would actively *prefer* that my psychiatrist have dealt with mental illness personally. I'm not all that convinced that someone who hasn't been depressed can actually know what it's like.
posted by mkuhnell at 10:59 AM on January 15, 2014 [2 favorites]

Marsha Linehan recently disclosed her mental illness

And I'm really glad she did, because it puts a lot of weight behind DBT, which is therapy I desperately need.

As to your specific situation, however, I would be concerned for the following reasons:

1) She is oversharing. Psychiatrists need to develop rapport with their patients in order to provide a fulfillinf therapeutic relationship. That doesn't include anything other than the bare bones details of their personal lives. The focus must be on you as a patient.

2) She is suffering, as OmieWise pointed out, from an uncontrolled mental illness. Three hospitalizations in twelve months is not a bipolar disorder that is being managed effectively. (Yes, bipolar 1/2/NOS are very resistant to treatment.) This could easily impact your therapy if, e.g., you show up for your appointment and she's in the hospital again.

So, personally (as someone with at least two and possibly four mental illnesses), I would be antsy about being able to trust that a) she's in a grounded state, b) she is doing the followup work needed when you're not actually in session (concerns about the low end of her cycle), c) that she will be there when needed and not in hospital, d) that if she is in a manic phase she would be able to react and concentrate appropriately in-session, e) that her illness is actually being managed by other psychiatrists.

Only you can decide for you whether or not these are issues that matter to you. If I were bipolar, I would probably be slightly less concerned inasmuch as she would have intimate understanding of the illness, but still, 3x hospital in 12 months is a Big Red Flag that maybe she needs to take some time off and stabilize.
posted by feckless fecal fear mongering at 12:44 PM on January 15, 2014 [2 favorites]

Please insert the following sentence up there: trust is the most important thing in a therapeutic relationship. Unless trust issues are specifically what you're working on, I would say (for myself at least) that a lack of trust would seriously hinder therapeutic efforts.
posted by feckless fecal fear mongering at 12:47 PM on January 15, 2014

You may be interested in reading the memoir An Unquiet Mind by Kay Redfield Jamison, a psychiatrist specializing in bipolar disorder who also has it. It touches on issues raised here and is also just plain interesting. I disagree with her take on depression, but then it was enlightening to realize how depression might feel to someone who also has manic phases.
posted by Comet Bug at 2:13 PM on January 15, 2014 [2 favorites]

A minor point: Kay Redfield Jamison is a psychologist. She is a Professor of Psychiatry.
posted by OmieWise at 2:49 PM on January 15, 2014

If that vein of learning about mental health practitioners who are also patients appeals to you as a way to wrap your mind around this, you might also investigate Lauren Slater. I think Welcome to My Country is probably where you'd want to start for your specific situation, though it's not my favorite of her books.
posted by Stacey at 2:55 PM on January 15, 2014 [1 favorite]

Hi everyone who answered my question. It's been 24 hours or so since I asked and I'm really glad I posted this. You have all provided insight and shared valuable information. Each of you.

I think I've mucked up the game a bit my 'favouring' ALL of your comments. I will probably re-read them all quite a few times. A few of you might get a private message from me. I don't think I can pick a "Best Answer". It is clearly not that kind of topic.

My friend I quoted in my Question is studying and working her way towards a Mental Health career of her own; she knows me very well and the series of events that have led me to where I am. I'll certainly share this discourse with her.

I will have some follow-up questions in the coming weeks, as the AskMefi rules and time allow.

I intend to keep my scheduled appointments. I am being medicated but I have a GP (or two) who can prescribe what I take. My hope/plan/intention is not to continue to see a Psychiatrist regularly very long term. Unless I find that it's really and truly beneficial of course.

A lot to think about. Thanks so much for taking the time to read and respond. The Green has never seemed so worthwhile and... Resplendent, to me.
posted by evil_esto at 1:58 AM on January 16, 2014

(Actually it was 24 hours exactly. I didn't plan that; how neat).
posted by evil_esto at 2:18 AM on January 16, 2014

I'm clearly late to the party but I wanted to wish you good luck! My therapist has also disclosed his experiences with mental health issues and I felt it helped to know he was approaching it from multiple perspectives, professionally and personally. Hope everything works out!
posted by dubadubowbow at 7:32 PM on January 26, 2014

Thanks dubadubowbow!
posted by evil_esto at 1:04 AM on February 6, 2014

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