A Man of Integrity

I was very impressed with the psychiatrist I saw on the single day referenced in this story.  In fact, I put a call into the clinic this morning to see if I could use his name.   It being six years ago, however, he might not remember me.  It being a very memorable event, however, he just might.   Then again, he struck me as such an amazing individual, it’s quite likely that all his visits are just as memorable.  So maybe he won’t remember me after all.  We’ll see.

I believe it was the year 2015 when I decided I would try to get a $20 monthly disabled bus pass, rather than continue to hike up my transportation bill with two dollar drops here and there.  Because a regular bus pass was $80 in Alameda County at the time, I figured it was worth a shot.

As I strolled into the clinic where a psychiatrist was to evaluate my case, I saw a young doctor approaching me from down the hall.  He seemed a bit distraught, or perhaps preoccupied.

“Mr. Pope,” he addressed me.  “Right this way.”

He sat me down in his office and started us off with something unusual.   Apparently, he needed a twenty-minute recording for some sort of presentation before some kind of board.  Thinking I might fit the bill, he asked if he could interview me.

“There is methamphetamine abuse in your history,” he began. “Would you mind if I recorded your answers to some questions first?  Then we can see about getting you your disabled bus pass.”

“I don’t mind at all,” I agreed — even though I did mind.  I never could shake the “tweaker tag” that followed me around, year after year, via medical chart.  I believe I signed something, and the interview began.

Although I don’t recall the exact line of questioning, I was quite surprised when he stopped the recorder about five minutes into the interview.

“I don’t believe you!” he cried. “You are not coming across like a tweaker.”

“Thank you,” I said.  

“In fact, you are coming across like a highly intelligent, perfectly capable and competent man.  I’m sorry, Mr. Pope, but I do not believe you have a legitimate disability, and I am hesitant to sign for your disabled bus pass.”

“Well, um — it probably says on my chart that I am bipolar.”

“Yes it does.  And you are showing no symptoms of bipolar disorder either.”

“That’s probably because I’m not bipolar,” I continued.  “Ever since I had an episode in 2004 that I believe to have been medication-induced, doctors have been reading the word ‘bipolar’ on my chart and not questioning it.  In fact, you are the first clinician who ever has.”

“Does this disturb you?”

“Not at all,” I replied.  “I take it as integrity.”

The doctor paused for a moment.

“I take your statements as integrity, as well.”

“I appreciate that,” I replied.  “But I must say, there really is something wrong with me, and it really does keep me from being employable.”

His interest piqued.  “What do you think is wrong with you?” he asked.

“Well, for one thing, I am able to perform complex tasks that most people find almost impossible — such as typing at an extremely fast speed and playing a piano just as fast.  I have no trouble organizing my thoughts into complex sentences, and to create impressive improvisational music comes natural to me.  However, I am incapable of doing the simplest things that most people do routinely.  I have a really hard time buttoning my shirt and zipping up my pants.   My hands seem only designed to type and play a piano.”

“Go on,” he said, seeming to be intrigued.

“I have great difficulty concentrating.  Oh, I concentrate fine — until I come up against a snag.  Then my mind drifts off into outer space, and I have the devil of a time returning to the intended point of focus.  Although I write profusely, I can count the number of books I’ve read cover to cover on two hands.   My mind spaces out when I’m reading, and sometimes even finds itself rewriting the book I’m reading — all before I realize what I’m doing.   Couldn’t get a college degree, in fact.  Couldn’t handle the reading load. “

“Stop right there!” he exclaimed excitedly.  “Now I have something I can use.”

He turned the recorder back on and let me speak for another twenty minutes.  Then I watched as he immediately picked up my papers, and signed for me to receive a disabled bus pass.

My jaw dropped open.  “Wow!” I shouted.  “What is wrong with me?”

“You’re ADD, man!!”

I tend to doubt that the good doctor will remember me — at least not by name.  And with the fast pace of the business in the Bay Area, he may well choose not to return my call.  It was that very fast pace, however, that led one doctor after another not to question the misdiagnosis they were reading on my charts.  In such an environment, it was certainly refreshing to encounter a doctor whose professional integrity exceeded his sense of hurry.   We’ll see if he returns my call.  

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Morning Cup of Crazy

In the year 2008, I was sitting at the breakfast table in the psychiatric facility of a certain hospital in California, when I noticed something disturbing. All of the other people had coffee — the kind with caffeine — but only I had decaf.

Naturally, I summoned a nearby psychiatric technician, and I asked him why I was given decaf, rather than regular coffee. I remember his name was Steve.

“Because you are bipolar,” said Steve, “a cup of coffee will hype you up, and put you at risk of having a manic episode.”

“But I drink coffee every morning, Steve,” I said calmly. “I find that my morning cup of coffee relaxes me, and helps me to focus.”

“If you were ADHD,” Steve continued, “your cup of coffee would relax you. But since you are bipolar, your cup of coffee hypes you up.”

“Well then, I must be ADHD, because my morning cup of coffee relaxes me. And really, Steve, don’t you think I know how my cup of coffee affects me? I mean, I’ve been having a cup of coffee every morning since I was 19 years old.”

“Andy,” frowned Steve, “I know that you sincerely want to be helped, but you seem to want to be helped on your own terms.”

At that, I could no longer suppress my outrage.

“My OWN terms?” I cried. “Me and a hundred million other Americans!?

(Granted, I was a bit agitated. But what do you expect? It was early in the morning before breakfast, and I hadn’t even had a cup of coffee yet.)

Long story short, my outcry attracted the attention of a number of other clinicians, and before I knew it, I was forcibly given a shot of concentrated Zyprexa on my tongue, before the words “I have the right to refuse any medications,” could emerge from my mouth.

What followed in the next few minutes is hazy in my memory. But evidently, I shortly later fell into a deep sleep. Either the next morning or the morning after, I awoke. A psych tech named Tim was standing next to me.

“Andy,” Tim said in a compassionate tone, “don’t make a big deal out of a cup of coffee here.”

I shot up from my bed. “WTF!!??”

Me being me, I made a totally big deal out of it! I went over people’s heads until I found the guy who was in charge of the place, who happened to be from Austria. Apparently, they do things a bit differently in Austria than they do in the San Francisco Bay Area. Or at least, he had a sense of right and wrong.

“That was horrible what they did to you!” he said. “And of course, you may have your morning cup of coffee from now on.”

Year 1 | Puss Bank School

I was considerably calmer each following morning, for obvious reasons. It also caused me to wonder if I had been misdagnosed. Later in Berkeley, a clinical psychologist and a psychiatrist both independently diagnosed me with ADHD, and both of them said I showed no symptoms of bipolar disorder.

Not to overemphasize demographics, but they do things differently in North Idaho, too. My present physician is considered to be an expert on mental health conditions. I saw him twice a couple weeks apart, and thought I was a little “manic” the second time I saw him. He reeled off five known symptoms of bipolar disorder and explained why I demonstrated none of them. Then he said, “If there were a line-up and I had to pick who was bipolar out of the line-up, I would not choose you.”

Prior to getting my Medicare and Medicaid with my retirement income, I was at the low income clinic where again I was disturbed that the bipolar diagnosis was on my chart, following me wherever I went. After much self-advocacy, which included accessing records from the psychologist and psychiatrist in Berkeley, the physician there diagnosed me with ADHD. I also took a test on my own — something I found on the Internet that seemed reasonable — that labeled me “Severe ADHD.” Then my physician gave me a test independently, yielding the same results.

I was put on the drug Straterra, and after three months of urinary retention and sleep paralysis, I stopped. I was able to urinate normally within two weeks after stopping, and the sleep paralysis stopped as well. I’ve not taken a psychiatric drug since then, although I’m certainly not opposed to the concept. I get tired of being a total space cadet. A little bit better focus, a little bit better reading comprehension, would be welcome. But you know, I also like my excellent physical health, and I don’t like it being messed with.

Maybe I’m proud. All I know is my morning cup of coffee relaxes me. Just ask my ex-wife.

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Tuesday Tuneup 82

Q. What’s happening now?

A. Just waking up.

Q. Now?   At 9 in the morning already?   Don’t you usually get up much earlier?

A. Usually at around 4:30.  But lately I’ve been getting up at 3, and this morning it all caught up with me.

Q. Why have you been getting up at 3?

A. Not tired anymore.

Q. What time are you going to bed?

A. That’s another thing.  It used to be, I’d go to bed at 9:30, and get a good 7 hours sleep.  Now, I don’t go to bed till 11.

Q. And you sleep till 3?

A. Yes.

Q. No wonder you’re so tired.   But doesn’t this remind you of something?

A. Yes it does, now that you mention it.   It reminds me of the time I always used to go to bed at 3, and get up at 7.   Very similar dynamic.   

Q. And when was that?

A. It was in 2003, right after Mom died.  Every night I stayed up till 3.   Every morning I got up at 7, and drove to the private school where I taught music.   That was the job that I lost in 2004.   I mentioned it in an earlier tuneup.

Q. Weren’t you having a first-time manic episode at the time?

A. Yes.  

Q. Are you afraid of having another one?

A. I don’t think “afraid” is the right word.   But I’m concerned.   I’m always concerned about this, as well I should be.   

Q. Is there any medication you can take to address it?

A. Perhaps.   I’m a little sensitive about it, being a runner.

A. What’s being a runner got to do with it?

A. My physiology is a lot different than someone who does not run.   So medications don’t have the same effect on me as they have on people who are more sedentary.

Q. Can you document that?

A. I can try.  I’m only stating my experience.   

Q. You haven’t always run, have you?   You’ve gone through periods when you don’t run much at all, right?

A. That’s right.

Q. How do medications affect you when you’re not running?

A. More like they’re supposed to, I think.  But check it out.  I didn’t run from about 2000 to mid-2003.   And I got super fat, by the way.   I was on 2400 mg a day of Gabapentin.

Q. Whatever for?

A. They believed it would be a good replacement for the Klonopin I had been on earlier, and less habit forming.

Q. But the Klonopin did not make you fat?

A. Not at all.  In fact, I requested they return me to the Klonopin, after I’d gained approximately 75 lbs.

Q. Did they accommodate your request?

A. Yes.  And then my Mom died, later that afternoon.

Q. So you think the combination of the medication switch and your mother’s death triggered the episode?

A. That’s my thinking, yes.   And psychiatry seems to agree with me, by and large, on this one.

Q. Does psychiatry often disagree with you?

A. I cant say that, no.   What I can say is — as a runner — I am always engaged in an experiment with my own body.   George Sheehan, in his book Running and Being, called it the “experiment of one.”  Since I continually experiment with my own body — that is, I develop theories, test them out, and draw conclusions — it disturbs me that someone who doesn’t know my body as well as I do should be experimenting with it.

Q. You don’t like doctors, do you?

A. I didn’t say that!  I just went to one yesterday, and I liked him very much.

Q. So what are you saying?

A. That I just have to hold this thing in check.

Q. You?  All by yourself?   Don’t you have a therapist?

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A. That’s right, I gotta find a good one.

Q. Were you going to a bad one?

A. Can’t exactly say bad — he just seemed, kinda like, he thought too well of me.

Q. Can you clarify?

A. I think he thought I was a lot more on the ball than I actually am.  First session, he kinda looked down as though guilty, and said: “You’re about twice as intelligent as me!” He said it in a tone of great self-pity, as though he were about to quit his job or something.

Q. He was insecure?

A. Yeah.  And now we had TWO insecure people in the room.

Q. So you left that guy?

A. Actually, he eventually quit the job.  And when he was leaving, he told me I should open up a private practice.

Q. And where did you go then?

A. To my pastor.   

Q. How did that go?

A. It was different.   Extremely intelligent, insightful, compassionate.   But somehow I felt as though something was cutting into my core — almost as though trying to create a disruption within me —

Q. Why would he have wanted to do that?

A. Oh, he wouldn’t have wanted to do it — not intentionally, not by his own self.  It was just an inadvertent effect of the logical progression of our mutual thought.   I left eventually, once I felt that something sacred within me was about to be desecrated.

Q. Sacred?

A. Yes.  Like an inner temple.  An adytum, if you will.   Something inside me that is so critical to my being, that no other influence has any business there.  Nobody, not even me, ought to tamper with that inner temple.

Q. So you felt threatened by the pastor, and you left that room as well?

A. You have such a crude way of putting things.   Yes, I left — but only because I then found a Masters Candidate who could see me for free, three times a week for five weeks, in order to fill out her hours for her Masters Degree.

Q. How was she?

A. Excellent!   I learned a lot in those five weeks.   But then she was done.

Q. Can’t you continue to see her?

A. Do I have $150 an hour?   

Q. Well then, what are you going to do?

A. I believe there are psychotherapists in my vicinity who accept MediCare and MedCaid.

Q. You gonna look for one?

A. It seems the humble thing to do, yes.

Q. Whoever called you humble?

A. No one yet.   May I be excused?

Q. Why?

A. Time for my morning run — and half the day’s gone already.  

The Questioner is silent.

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