I read a list post yesterday from a good friend, a bipolar, whom I'll call John. It almost broke my heart:

I went to my second appointment with the new therapist yesterday and it was hell. I first tried to inform her of the events of the weekend. I had the worst episode I have ever had. I explained that I could and would take the anti-psychotics now.

She began asking questions as if to discount what I was saying. It appeared she was discouraging me from medication altogether.

She carefully turned the conversation to her agenda as she began explaining "borderline personality traits". She asked if I knew about borderline personality. I told her some of the things I had learned but kept back the fact that I knew the prognosis was bleak, and even if some resolution was possible reoccurrence was likely.

I had a hard enough time hearing the words "bipolar disorder" (BP), and then she said I have the double whammy of BP and BPD. Well, I felt that sinking feeling as if I was dying inside forever. I was silent as the battery of information she selectively read crushed me, in an apparent effort to prove her theory of a new and more devastating disorder.

I left feeling so empty inside and lost -- not sure if I could handle another blow to the old self-esteem. I have liked all the therapists I have ever had, but this woman was without compassion, without any insight as to how I might react to this.

In group I was asked why I didn't confront her about my feelings. I was encouraged to go back Monday and explain to her that she was moving too fast and squashing my self esteem.

John

John, no therapist has a right to push you around like that. And she is pushing you around. To go back to her and explain that she is demeaning you is to imply that she does not know what she is doing. She does.

It's the same old problem: labeling. Human beings love labels; labels simplify things so nicely. Fine. But, psychiatrists, please, hold off on labeling people!

OK, psychiatrists may need to silently label their clients. But they don’t have beat their clients over the head with the labels. And they certainly don’t need to try to convince their clients that a particular label applies to them, as if they were potential religious converts.

Here's a possible scenario that involves no labeling:

Psychiatrist: How are you doing?

Client: Last weekend, I had the worst episode I ever had. I'm ready to take anti-psychotics now.

P: What was your episode like?

C: I had terrible hallucinations . . .

P: Anti-psychotics are effective for hallucinations, but there are other drugs that may be more effective for your particular hallucinations. Would you like to read some of the studies comparing the effectiveness of these drugs?

See how the psychiatrist was informative without being pushy, suggested treatments without labeling the client? It can be done.

John, you may wonder what will happen if you assert your right to this kind of treatment next time you visit your psychiatrist. Will she cut off your meds? No. That would be against the law. The most she could do to you is transfer you to another psychiatrist.

The best approach would be to gently explain to her that you really don't care what your label(s) is/are, that you just want to find the medication that will best treat your symptoms. If that medication is normally used to treat borderline disorder, so what? Bipolars often respond very well to medication normally used to treat epileptics. That doesn't make us epileptics. .