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How certain is a psychiatric diagnosis?

Interview with Peter Øvig


 

Peter Øvig trained as a journalist in 1987 and together with Ina Kjøgx Pedersen he published in 1987 the book “Er du da sindssyg?” (Are you crazy?) in which they took a critical view of the psychiatric system. His books include portraits of authors as well as historic books documenting some of the delicate aspects of the 20th century with a focus on what makes human beings cross the norms of society. His latest book from 2023 “Dem der ikke tier” (Those who do not keep silent) is a critical description of sexual violations that have taken place in Danish orphanages.



Marianne Kastrup: In a previous issue of Nordic Psychiatrist (Spring 2020) you described your psychiatric illness but how did you experience receiving a psychiatric diagnosis?


Peter Øvig: My mother had a manic-depressive disorder as it was called at that time, and I felt that she did not receive sufficient help. Personally, I was at that time - as reflected in my book “Er du da sindssyg” – influenced by the anti-psychiatric movement believing in alternative forms of care and being very critical towards psychiatry in general and diagnostic labelling in particular seeing diagnoses as convenient boxes to place people in.


Later I realized that I too had mental problems. But for a long time, I called them “black holes”, “melancholia” or other metaphors not accepting that I might suffer from a depression.  At a certain point I contacted my general practitioner who prescribed some medication and the first time I became aware of a psychiatric diagnosis was when I stood at the pharmacy and read the label on the tablets “To be taken against depression”.


Many times, patients experience that the primary diagnosis is changed over time. Did you experience that too?

Peter Øvig's book "My mother was possessed" from 2019 describes the mental illness of his late mother as well as his own major depression. Image by Peter Øvig's father.
Peter Øvig's book "My mother was possessed" from 2019 describes the mental illness of his late mother as well as his own major depression. Image by Peter Øvig's father.

I tried different forms of treatment as a consequence of my desperation. I felt so miserable without any energy that I was looking for any kind of therapy that might help me. I tried healing, massage, etc. and none of it helped me. In the serious phase of my illness, I had also a brief pointless contact with a psychiatric emergency clinic. So, all efforts were futile until I got into contact with the established psychiatry as my depressive condition deteriorated. Here I was told to be aware of any periods of a manic or hypomanic nature. I was diagnosed with a severe psychotic depression but when I was discharged, I saw that I was given a diagnosis of having a bipolar disorder. As neither my partner nor I could recall any manic episodes she objected to this diagnosis.


Subsequently I understood that the treating psychiatrists had discussed my case and in the light of my extensive production of books etc they found it was likely that I had had bouts of high energy that allowed for the diagnosis bipolar disorder.


So, you may question whether my diagnosis was “certain”.


Do you find this uncertainty was problematic?


No not really. Once I was in a meeting with a group of psychiatrists from another hospital and here, I experienced being a spectator to a debate whether I had a diagnosis of bipolar disorder and if so whether it was bipolar type 1, 2 or maybe type 3. But for me receiving a specific diagnosis was not the most important; receiving the right treatment was. I have been fortunate in the sense that I was suffering from a psychotic depression but had the appropriate treatment with the result that I could return to a productive life. I have described my situation as being in a kind of catapult thrown back to normality when I recovered, and I am today thankful that I followed the advice given and accepted that ECT treatment was the appropriate treatment in my case.


How do you look at psychiatric diagnoses today?


I have in some way been lucky as I have not experienced the shift of diagnoses that I am aware of is frequently the case in psychiatric patients. It seems strange that the same condition can be seen from so many angles with different diagnoses as a result. I have met many psychiatric patients who have found this diagnostic uncertainty frustrating sometimes with a resulting lack of confidence in the therapists. But even with the right diagnosis uncertainty may prevail in the sense that you may try 4-5 different kinds of medication before you get an effective one. □



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