I was diagnosed with bipolar for convenience only. I was put on lithium prior to any definitive diagnosis, then, so that I could be put on disability I was called schizophrenic. That was the default diagnosis for the facility where I was held. A few years later my parents pointed out to my new doctor, Dr. John Merrifield, that I didn’t have any of the characteristics of schizophrenia. Merrifield likely wanted to keep me on a “severe” type diagnosis but conceded to my parents regarding my supposed “schizophrenia.” Now what? I wasn’t really depressed enough to fit the “severe depression” category so he pegged me with “bipolar.” My parents were relieved at this. I remember he raised his one eyebrow before announcing this during a family “therapy” session. My mom was so relieved that she exclaimed, “Hooray!” I gave her a sharp look and she recoiled from her glee, wondering why I might have been upset.
I was wrapped up in what my mother had said, but barely cognizant of my own reaction my supposed “bipolar” diagnosis. Not long after the doctor’s announcement I began to take on all the characteristics of bipolar. I started having mood swings. The problem was that I cycled a little too rapidly for a real bipolar, if there is such a thing. He then pronounced me “rapid cycling.” I was never truly manic or deeply depressed for very long. I didn’t want to admit that these moodswings followed my eating disorder, going up when I did not eat, and going down every time I binged.
Several times, I tried telling Merrifield about the bingeing.
“Bingeing?” he said, as if he had not heard I had an eating disorder.
“On food,” I explained.
“So long as it’s not alcohol,” he mumbled, then changed the subject.
I finally concluded that there were no solutions to my eating disorder and that my complaints were very trivial and selfish. I stopped mentioning it.
I heard somewhere that schizoaffective disorder was used at one point as a default diagnosis before borderline personality disorder came into fashion as the new default for women. For instance, after I had shock treatments I wasn’t making much sense. This was when my “bipolar” diagnosis quietly morphed into schizoaffective for me.
I was confused, so I didn’t have a clue why I was confused. I had no way of distinguishing ECT brain damage from “mental illness.” Apparently my doctors couldn’t, either. They called me Borderline and claimed I was “dissociating.” However, a quick glimpse, even in 1997, into what dissociating was supposed to be told me that the doctors were way off the mark.
My guess is that for many patients, either ECT or psych drugs themselves will cause a similar morphing of diagnosis due to changed presentation. Either that or the patient will be put into the schizoaffective category due to being “difficult to treat” or due to clinician frustration or even dislike for the patient.
Schizoaffective is convenient for the clinicians because at any given time, the patient can be called manic or psychotic. At any given time the patient can be drugged with a wider assortment of powerful pharmaceuticals. Schizoaffective justifies all sorts of psychiatric tortures. Because the diagnosis sounds scary might cause the cops to assume you are violent and shoot you before they do anything else, even if they can’t quite pronounce schizoaffective. It is in your best interest not have anything sounding like schiz on your medical record (or filed with your local police)!