I immediately knew what she meant.
The book has so infiltrated the psychiatric world that we can use it as shorthand.
I, too, have read the book and seen the2016 Netflix moviebased on the text.
Portrait of Susannah Cahalan / Image courtesy of Shannon Taggart
Thats exactly what happened to Cahalan when she was 24 years old.
One doctor diagnosed her withbipolar disorderand put on psychiatric medication.
Another doctor told her she was experiencing alcohol withdrawal (though she barely drank).
As a psychiatrist, I had the same concern when reading her book.
Both Cahalan and I were left contemplating the imperfection of diagnosis in medicine, particularly in psychiatry.
), it’s a fascinating read.
Here, Cahalan discusses her experiences with psychosis, misdiagnosis, and psychiatry in general.
SELF: What do you remember about being sick?
Cahalan:I remember what I now realize werehallucinationsand delusions.
That delusion followed me from his house to the hospital.
How would you feel if your father had murdered someone and then was after you?
It was complete and total fear.
I dont think Ive ever been that scared in my life.
SELF: What was it like for your family when you were having those experiences?
Cahalan:It was very confusing and extremely frightening.
They didnt understand why I was suddenly behaving completely irrationally and they couldnt talk me out of it.
It would wax and wane.
I think this is true of anyone who feels psychosisit comes and goes.
SELF: When you were first misdiagnosed with bipolar disorder, what was that like?
Cahalan:I think the scariest thing for a lot of people is to have no diagnosis.
When I was researching, I thought, I am creative, I am prone to this or that.
It made sense within that context, and it didnt feel threatening.
Bipolar disorder, I think, has less stigma thanschizophrenia, which can also cause psychosis.
If I had been diagnosed with schizophrenia, I think I would have had a different relationship with that.
SELF: How did it feel to find out that your diagnosis was neurologic and not psychiatric?
Cahalan:I only really started to understand that when I was very much along the path of recovery.
This was all cemented by, Oh, but it was my body attacking my brain.
I could explain why, and that was very comforting.
I felt like I was on stable ground in talking about my psychosis within that context.
But I now realize that this thought processthough entirely unconsciouscontributes to the rampant stigma directed at mental illness diagnoses.
Its a moving target.
What you realize is thatmental healthdiagnoses are created by people, so they go through reappraisals.
Thats something I didnt really know as a layperson embarking on this book.
SELF: Did you previously think diagnoses had more grounding in fact?
I thought they were objective truths.
Even blood pressure guidelines, those things change.
The list goes on.
I didn’t realize that before.
SELF: Did you have any difficulties discussing the history of psychiatry in a balanced way?
I realize I do come with my own biases, and the book is biased in its own way.
But I tried really hard to be as fair and balanced as possible.
Its almost like a Rorschach test.
SELF: I had points where I found myself really defensive and others where I completely agreed with you.
Did you expect people to have that reaction?
Cahalan:I wanted people to go through the experience that I went through in researchingmy feelings in real-time.
That was the goal of the book.
To go through these realizations and discover these limitations.
SELF: How did you feel about psychiatry by the end of the writing experience?
Cahalan:I really do feel that things are going to change.
I think most people are doing their best and really working hard and should be celebrated.
That is where I ended up.
It all comes down to that.
This conversation has been condensed and edited for clarity.
