ask dr-robert

I am from the New England. I am 29 and I have been diagnosed as bipolar for many years now, but I strongly believe that I also have Avoidant Personality Disorder, with some traits of Schizoid PD as well. My own doctor dismissed the issue immediately as soon as I brought it up. It was hard enough for me to bring it up and now I can't even speak to him about it, because it falls on deaf ears. I am desperately trying to find someone who will listen to me and give me a diagnosis. Is there anyone ANYWHERE who specializes in this? I would like to see a professional who will take this seriously, as I feel this disrupts my life even more than bipolar and probably plays a large role in my mood swings. Where can I get help for this?

Thank you,

Elaine



Hello, Elaine--

It is entirely possible for the same person to suffer from bipolar disorder, and also to manifest features of avoidant or schizoid personality disorder. In fact, it is not at all uncommon for the same person to have to deal with two different and unrelated mental disorders, both of which require expert, and different, treatment. Perhaps this is the case with your situation. If you feel that you have avoidant or schizoid personality problems, chances are that you do.

Now, bi-polar illness is best managed with proper medication, but personality disorders require expert, intimate, ongoing psychotherapy. And offering that kind of therapy is a demanding, sometimes difficult process. I am wondering if your doctor simply is not up to such a task, and so did not want to hear about any personality problems.

You did not say if your doctor is a psychiatrist, psychologist, or some other kind of doctor with less training in mental health. Assuming that your doctor is a person properly trained in diagnosis and treatment of mental illness, he or she had a positive obligation to discuss the matter of avoidant personality and schizoid personality with you in a serious way as soon as you raised the question. In fact, no reputable psychiatrist or psychologist in my experience would dismiss out of hand such a question without at the very least asking the patient a question such as, "Why do you think that?" or "Why does that come up for you?".

Sadly, there are many people in the mental health professions who imagine that they know more than they really do, and so have stopped asking their patients to teach them the specifics of the patients' experiences. This is tantamount to malpractice--after all, each person's world is a largely unexplored universe, and the duty of the doctor is to help the patient to explore and come better to understand that universe. Real psychological expertise does not mean knowing how much one knows, but how little. All of the best people in the psychology field in my acquaintance follow the example of the great psychologist Carl Jung who would always say to himself as he opened the door to admit a new patient, "I know absolutely nothing about this person."

I am sorry that you were made to feel that you could not get the help you need from your present doctor, and so needed to consult me via internet, and now will have to go through the trouble of finding a new doctor. However, I certainly encourage you to go to that trouble. Mental illness can feel terribly isolating and sometimes frightening even with the help of a doctor who knows how to listen, understand, and respect the experience of the patient. Without such a competent doctor such illness might feel unmanageable.

A person with your kind of illness needs a doctor on whom she or he can rely totally, not just to prescribe medication, but also to be there faithfully to listen to and to understand whatever concerns you might need to express, so if your present doctor is not that kind of person, by all means find another as soon as possible.

Unfortunately, here in Todos Santos, Mexico, I am far distant from New England, and cannot recommend any one specific doctor to you. Please phone the best hospital in your area and ask for the department of psychiatry. When you get someone there, ask for a referral to a psychologist who is expert in both bipolar disorder and in providing psychotherapy for personality disorders. If the first referral is not satisfactory (in the sense that you feel that your concerns are being heard and understood), please persevere until you find someone who seems both kind and knowledgeable (one is no good without the other).

If I can be of further help, do not hesitate to write.

Be well.