My diagnosis at Alhambra CPC included CAT scans of my head, blood and urine tests and neurological tests to rule out such things as tumors and poisoning. A psychiatrist will usually do a thyroid panel before treating someone for manic depression. (There was another patient at Alhambra who arrived in a catatonic stupor and slowly awakened during our time there. It turned out that he had a physiological condition that caused the buildup of ammonia in his blood.)

However, there is no blood test for psychiatric illness; at best blood tests can rule out other physiological conditions. Tests such as Positron Emission Tomography can detect such things as the excessive metabolization of sugar in the right brain hemispheres of manic people, but PET scans are very expensive and so only commonly performed for research purposes.

Diagnosis of a mental disorder is made from the patient’s history, observation of the patient’s current behavior, talking with the patient, and psychological diagnostic tests.

I had the Rorschach Inkblot Test, the Thematic Apperception Test, in which I explained what I thought to be happening in some pictures, and the Minnesota Multiphasic Personality Inventory in which I answered a lengthy questionnaire about my thoughts and feelings.

I also took an IQ test. Being manic I was feeling quite intelligent, so I was appalled to find that my score was off about 20 points from the two IQ tests that school psychologists had given me as a child. The psychologist who tested me in the hospital reassured me that my brain was not degenerating, but that psychosis caused a temporary decrease in intelligence. She said my intelligence would recover when the episode passed. However she warned me that my intelligence would fail to recover fully if I had repeated manic episodes.

If you don’t have the money to pay for treatment you may still have options depending on where you live. Even in the United States, which does not have publicly funded health care for most illnesses, there are government-supported mental health clinics in many communities, as well as private nonprofit clinics that charge their patients based on their ability to pay.

Many psychologists and psychiatrists offer sliding scales, where they charge lower-income patients less money. Not everyone offers this, so you have to call around.

Some psychiatric medications are expensive; treatment with clozapine for schizophrenia costs thousands of dollars a year. The government might assist in the cost of your medicine, and some drug companies offer “compassionate drug plans” in which qualifying patients receive their medicine free of charge directly from the drug company. In addition the drug companies often give psychiatrists free advertising sample packs of drugs, which the psychiatrists then give to their patients who cannot afford to buy them.


Q: How many psychologists does it take to change a lightbulb?

A: Just one, but the lightbulb has to want to change.

Early on, in the year before my diagnosis and for a while afterwards, I saw a number of psychologists. (I had also seen one for a while when I got really depressed in eighth grade, and had also seen a couple of school psychologists in elementary and junior high school, but didn’t feel any of them helped much because I was such an unwilling patient.) I would typically seek a therapist out because I felt really bad, but after a few months I would feel better and stop going. Early on I really disliked having anything to do with psychologists and wouldn’t see one any more than I absolutely had to.

That’s a pretty common phenomenon for therapy patients. It seems that many of the people who seek out therapists are not in a position to get better in any substantial way, because they have no commitment to making any real change in their lives.

Achieving real change is a lengthy process, and it is often painful. Seeing a therapist just until you feel better for a while is not likely to effect meaningful change. And in fact for a bipolar person it’s not likely that the therapist will have made any difference in such a short time – you could consult a brick wall for your depression for a few months, and after a while the inevitable bipolar cycle will make you feel better.