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DrFee
DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience:  I help people overcome anxiety and enjoy life again.
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I am a 60 year old male, Vietnam veteran, who was diagnosed

Resolved Question:

I am a 60 year old male, Vietnam veteran, who was diagnosed in 1996 with PTSD and depression. Beginning in 2006 my VA psychiatrist began slipping in a possible Bipolar and then Bipolar later on. I do not feel this has ever been fully discussed with me as to why and as to a treatment plan, etc. I am now questioning this. My specific question is that while yes, I do exhibit some levels of criteria for Bipolar, my research indicates that, in my opinion, this is within both the normal spectrum for the average person combined with PTSD. Any suggestions how I can approach the topic of seeking a evaluation of criteria and diagnosis?
Submitted: 2 years ago.
Category: Mental Health
Expert:  DrFee replied 2 years ago.

DrFee :

Hello! Please remember that my response is for information only, we are not establishing a therapeutic relationship.

DrFee :

Are you planning on doing this through the VA ?

DrFee :

Psychologists tend to do a lot more testing than Psychiatrists do (who mainly evaluate by asking questions), I think I would ask to see a Psychologist and explain to him/her what you just said to me --and ask for a full diagnostic evaluation.

Customer:

Yes, I am still working with my VA social worker and have filed with the VA a letter to discontinue all VA psychiatric care, including medications. This has garned a response from to VA to evaluate my concerns. I realize discontinuing meds is at risk, I am working with the social worker, and know it will take work, combined with a step down in emotional stability.

Customer:

I do realize that this is informational only.

DrFee :

Did they/will they work with you to get off of the meds? Thanks for reading the disclaimer. :)

Customer:

I am wondering how I can better position myself to be able to understand what is best for my care and not just throw it upon the doctors

Customer:

What I did regarding meds is to first cut them in half for about 11 days, then discontinue them completely. In talking with my social worker she seems to think I am doing well. I will also seek help if needed and I do have a good support system.

DrFee :

Well, I think that it is best for you to have an evaluation that is comprehensive, and a treatment plan that is presented to you in a way that makes sense. There is nothing wrong with asking for that, and if you stay calm and professional about it, then hopefully they will too.

DrFee :

OK...I'm glad to hear that, about how you did it and the support that you have.

Customer:

I am at a place that I am not concerned what the diagnosis is, but rather what is the correct one.

DrFee :

Yes --that makes a lot of sense.

DrFee :

Do you have to deal with the same people you have been dealing with, or can you get new people?

Customer:

As a side note, and this actually does not pertain to me, in the state of Texas you cannot qualify for a concealed handgun license if you have been diagnosed Bipolar. I do not like the government having that kind of say so. Strange, I know, but hey.

DrFee :

Interesting. I did not know that.

Customer:

I changed Va psychiatrist this year and the new one simply went with the chart diagnosis, said continue meds and come back in 6 months.

DrFee :

That is frustrating. Have you ever talked to a Psychologist there?

Customer:

I am supposed to be meeting with someone to discuss this matter and I would like to be prepared to dialogue on the matter and not just be defensive (or offensive), which I suspect the VA doctors and system will do. How can I better prepare an explanation for what my mental status is as well as mental history?

Customer:

My online research indicates I do exhibit characteristics of Bipolar but not conclusively. No person, who knows me, thinks I am Bipolar.

Customer:

some of them have worked with Bipolars and have family member who are.

Customer:

That is a possibility my primary clinic has brought up

DrFee :

How about something like this: "When I was first diagnosed, of course I accepted the diagnosis. But over the last X number of years, I began to suspect that perhaps my symptoms and struggles are not due to Bipolar but can be better explained by the PTSD. I know that I'm not a doctor, but I really would like to have a full psychological evaluation so that we can understand my diagnostic picture. I'm dedicated to overcoming my difficulties, and I would like to have a treatment plan that I can understand and participate in."

Customer:

What I perceive as a difficulty is that I am not a trained, credentialed or licensed expert

Customer:

Thank you, XXXXX XXXXX a good approach. It seems like the boundary between PTSD and Bipolar do cross or intermingle.

DrFee :

True -- but a good professional will listen to his/her patient. If they don't listen, there's a problem. Can you go higher up if they don't listen?

DrFee :

Maybe if you have a few XXXXX XXXXXnes if they get defensive: "Yes, I know I'm not a professional, but I need a better understanding of my diagnosis."

Customer:

I did have a full psychological workup in 2009 for my ratings. In the VA that is called a C&P exam for compensation and pension. (FYI in case you are not familiar with the VA

DrFee :

"No, I'm not saying I know more than the doctors, but I do need to understand my treatment plan."

DrFee :

Oh, OK --what were the results?

Customer:

There was no clear statement of Bipolar but as I recall my Mississippi test rated 131 for PTSD

DrFee :

OK, then you could ask, "Can you explain to me why in my 2009 evaluation there is no indication of Bipolar?"

Customer:

My initial diagnosis for PTSD was 1996. I have discussed with my social worker and my VA group that I feel I have learned a lot of tools to have in my tool box to deal with situations that arise.

DrFee :

That wasn't the best wording --but basically asking them to explain that evaluation to you ---

DrFee :

Have they ever given you any psychotherapy for the PTSD --- like EMDR or TF-CBT is another popular approach (I prefer the EMDR)

Customer:

Okay, I am printing this conversation out as we go so I can refer back to it. It is being helpful.

DrFee :

Good --I'm glad

Customer:

My original social worker was trained in EMDR and we did some of it and it was very useful and eye opening.

DrFee :

Good, I'm glad!

Customer:

One problem I have with the current psychiatrist is that in 2006 I entered a in-patient PTSD program at the VA hospital which also has psychiatric services. But I was not in a psychiatric program rather a PTSD on. the psychiatrist kept referring to me being admitted to the psychiatric hospital program. This is a bone of sore contention.

Customer:

one

DrFee :

It sounds like another example of not being heard or understood by him.

Customer:

You have given me some good places to direct my approach. What I have made clear to the VA is that if I will not be heard I will seek outside care from medical professionals qualifed with PTSD and Bipolar.

Customer:

And through that avenue seek for a reevaluation

DrFee :

Yes -- I hope that they will hear you though, and that you aren't forced to go outside.

DrFee :

But, at least it sounds like you have that option.

Customer:

and a new and current diagnosis

Customer:

yes, one thing I do realize is that I am the person responsible for my health care, not someone else. yes, they may be part of my healthcare team and I need to trust them but the responsibility falls on me.

DrFee :

True --But the services should be appropriate and good at the VA --I know they are people too, you could have experienced the same thing in the private sector.

Customer:

Yes, the VA has many, many very good people. But, like everywhere they do get overwhelmed and at times get caught up in the system of doing things.

DrFee :

Yes, I do understand that. It really sounds like you are going to be able to approach them with an appropriate assertiveness.

Customer:

thank you

DrFee :

And --either they will be responsive, or they won't --that part you can't control!

Customer:

Well, it is late and I need to sign off. Thank you for your time, it has been helpful.

Customer:

Exactly, when I began approaching the subject I realized where my control abilities were and were not.

DrFee :

You are welcome. Take good care.

DrFee :

And best wishes

Customer:

Have a good week and a happy July 4th

DrFee :

Thank you, XXXXX XXXXX!

DrFee :

Thank you for your service for our country!

DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience: I help people overcome anxiety and enjoy life again.
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
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