Just my thoughts on dealing with people that have struggles accepting their blind spots, the unknowns, and their hidden agendas.
I have common problem for some patients seeking consult wanting to "figure themselves out" because of their mental health problems. I do the routine diagnostic interview and get an impression on the first take. Some patient's don't really mind any labels while others just want some affirmation even if it's not exactly what they want to hear. It's a common thing but there will be one of those types that become pushy and insists on having problems with the label.
From a textbook standpoint, all the checklists ticks off that they definitely have Bipolar Mood Disorders but refuse to acknowledge this part about themselves. It runs in the family and they saw how someone in their family suffers from it and therefore try their best not to be tagged with it despite the obvious symptoms they've been experiencing or are trying to be selectively aware of.
I'm not going to make this about symptoms or diagnostics. I'm more focusing on the reaction of people. The trouble I encountered here is how poor their insight is despite seeking multiple consults between other practitioners telling them what they already needed to hear but refused to acknowledge and felt misheard.
Below is the diagram for the Johari's Window. One way to examine how we see ourselves and how others see us which enhances our perception of self image.
You can refer to the source linked above to have a better grasp on the subject since the site can do a much better explanation on it that I could come up with while writing this post.
When I hear someone say "I know myself better than anyone" and I just think of this diagram. they're at the open area and hidden area. But even strangers can make good assessment of people by focusing on the blind spots. It's called a blind spot for a reason. And you reduce that corner by getting to meet more people talking about what you don't notice about yourself.
Going back to the case above.
My impressions for this person:
- They want to be labelled as having ADHD because that's more acceptable than be tagged as Bipolar.
- Their experience having family members (parents and siblings) living with Bipolar shaped their perception about having the disorder and would consciously block all ideas that suggest that the chances of acquiring it themselves is high.
- To acknowledge that they don't have ADHD and are Bipolar because of 1st and 2nd point meant they a compromised ego defense and a threat to self image. So their course of action is to lie about their symptoms, become resistant and go doctor hopping for affirmation.
- After hearing from previous doctors that handled their case, I found a consistent pattern where they would lie or downplay some symptoms. They can lie consciously or unconsciously because they don't want the label and are actively researching their diagnosis to know what to answer to get what they want.
Areas where I give myself doubt:
- I don't necessarily subscribe to what other doctors think and prefer to keep my own observations on high priority. But if multiple doctors are consistently telling me something, I can't ignore the patterns.
- ADHD could still exist with Bipolar so they could have traits of it but not enough for me to have confidence to call it ADHD.
- I'm just being nice and prefer not to be confrontative about what I think of them. Even if majority of my experience and intuition all points to the simpler diagnosis of Bipolar Mood Disorder, it's still not the right time to break it down since they could have better treatment outcomes if I just encourage them to take some meds and once stable, slowly build those insights.
It's draining to deal with these types. I'm not treating a disorder, I'm treating a person so my focus is now is trying to get them to see their blind spots.
Thanks for your time.