should figure things out for themselves. This happened when I was manic. When I am depressed, I sleep a lot, and come to class unprepared. I talk slowly and I donât meet my duties.
Dr. Dean: Do you feel normal?
Mr. Anderson: No, not since stopping the lithium. Since being off the lithium, I would say I have been more manic.
Dr. Dean: Do you have any delusions?
Mr. Anderson: That I am competent to do what I canât, to work with mathematical models I donât have training for. I put articles on the syllabus I donât understand.
Dr. Dean: This is not a delusion, but overconfidence. What is the worst thing about the depressions?
Mr. Anderson: When I got the letter from the department saying I was out of the classroom. I had lost my job, and was really down.
Dr. Dean: Do you experience rapid cycling?
[Mr. Anderson describes in some detail the variation in the lengths of his moods.]
Dr. Dean: Do you go through a normal state there for a minute in between?
Mr. Anderson: That would be the smallest time, and it is the only time I feel normal.
Dr. Dean: Can you bring the moods on? Can you change your mood?
Mr. Anderson launched into a long and involved but coherent narrative about his experiences working in industry and his decision to move to academia. Dr. Dean tried unsuccessfully to interrupt him a couple of times. After the interview ended, Dr. Dean turned to the group.
Dr. Dean: Was this an easy diagnosis to make? [The first two students he called on hesitated and could offer no answers.] We need some help for our friends here. How would we describe his speech? What is pressured speech?
Student: The person canât get the words out?
Dr. Dean: No, it is the opposite, you cannot interrupt. You canât get a word in. He qualifies. He goes off on tangents and doesnât answer the question. You could use the word âcircumlocutionâ if he eventually gets back, but I despaired of him ever getting back several times.
Is it a thought disorder? We look at his syntax and semantics. Is the syntax loose, is he distracted? And his semanticsâis he appropriate?
Students had trouble answering these questions, but Dr. Dean summed up the consensus that Mr. Anderson did not have thought disorder.
Dr. Dean: Maybe he is a normal variant. His condition is especially common among professors. This is a gray zone.
Dr. Jones: It is not clear-cut. His pattern is not at all uncommon, especially among writers and artists.
In this case, since several criteria of schizophrenia or schizoaffective disorder were lacking (delusions and thought disorders), the physicians in the room focused on the diagnosis of bipolar disorder. Since he had many positive signs of manic depression, the treatment recommended at the end of rounds was restarting a low dose of lithium, in hopes that the renal problems would not recur. Nonetheless, Mr. Anderson was placed in a âgray zoneâ between mental illness and mental health, perhaps because the doctors identified with the patient and his brilliant youth, followed by his faltering middle age. His moodiness, his occasional overreaching of his knowledge, and his travails moving between academia and industry might have been all too familiar. A certain generosity might also have been flowing from Mr. Andersonâs gratitude for the medical treatment he received at Wellingtown Hospital and his open expression of insight into the pathological features of his condition.
(8) Iâm a Twenty-Year-Old College Student with a 3.75 GPA and I Am Not Crazy
Dr. Paulson presiding, a resident presents the case.
This is a twenty-year-old African American male admitted in the emergency room at Riverside Hospital [pseudonym for a recently built medical complex in Baltimore] with a strong suicidal gesture: he said he wanted to blow off his head with a gun, and he actually did have a gun. He grew up in Newark, where his parents were drug dealers and users. He had a pattern of working
Dr. Dean: Do you feel normal?
Mr. Anderson: No, not since stopping the lithium. Since being off the lithium, I would say I have been more manic.
Dr. Dean: Do you have any delusions?
Mr. Anderson: That I am competent to do what I canât, to work with mathematical models I donât have training for. I put articles on the syllabus I donât understand.
Dr. Dean: This is not a delusion, but overconfidence. What is the worst thing about the depressions?
Mr. Anderson: When I got the letter from the department saying I was out of the classroom. I had lost my job, and was really down.
Dr. Dean: Do you experience rapid cycling?
[Mr. Anderson describes in some detail the variation in the lengths of his moods.]
Dr. Dean: Do you go through a normal state there for a minute in between?
Mr. Anderson: That would be the smallest time, and it is the only time I feel normal.
Dr. Dean: Can you bring the moods on? Can you change your mood?
Mr. Anderson launched into a long and involved but coherent narrative about his experiences working in industry and his decision to move to academia. Dr. Dean tried unsuccessfully to interrupt him a couple of times. After the interview ended, Dr. Dean turned to the group.
Dr. Dean: Was this an easy diagnosis to make? [The first two students he called on hesitated and could offer no answers.] We need some help for our friends here. How would we describe his speech? What is pressured speech?
Student: The person canât get the words out?
Dr. Dean: No, it is the opposite, you cannot interrupt. You canât get a word in. He qualifies. He goes off on tangents and doesnât answer the question. You could use the word âcircumlocutionâ if he eventually gets back, but I despaired of him ever getting back several times.
Is it a thought disorder? We look at his syntax and semantics. Is the syntax loose, is he distracted? And his semanticsâis he appropriate?
Students had trouble answering these questions, but Dr. Dean summed up the consensus that Mr. Anderson did not have thought disorder.
Dr. Dean: Maybe he is a normal variant. His condition is especially common among professors. This is a gray zone.
Dr. Jones: It is not clear-cut. His pattern is not at all uncommon, especially among writers and artists.
In this case, since several criteria of schizophrenia or schizoaffective disorder were lacking (delusions and thought disorders), the physicians in the room focused on the diagnosis of bipolar disorder. Since he had many positive signs of manic depression, the treatment recommended at the end of rounds was restarting a low dose of lithium, in hopes that the renal problems would not recur. Nonetheless, Mr. Anderson was placed in a âgray zoneâ between mental illness and mental health, perhaps because the doctors identified with the patient and his brilliant youth, followed by his faltering middle age. His moodiness, his occasional overreaching of his knowledge, and his travails moving between academia and industry might have been all too familiar. A certain generosity might also have been flowing from Mr. Andersonâs gratitude for the medical treatment he received at Wellingtown Hospital and his open expression of insight into the pathological features of his condition.
(8) Iâm a Twenty-Year-Old College Student with a 3.75 GPA and I Am Not Crazy
Dr. Paulson presiding, a resident presents the case.
This is a twenty-year-old African American male admitted in the emergency room at Riverside Hospital [pseudonym for a recently built medical complex in Baltimore] with a strong suicidal gesture: he said he wanted to blow off his head with a gun, and he actually did have a gun. He grew up in Newark, where his parents were drug dealers and users. He had a pattern of working
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