QUESTION:
Dear Dr. Heller,
My sister (age 39) has been in and out of mental hospitals 4 times over the last 4 years. Her first hospitalization occurred 6 weeks after the birth of her 3rd child. There is a suspicion that there has been mental and emotional spousal abuse that has just come to light. She has been diagnosed obsessive-compulsive, manic depressive and one therapist even said that there may be schizophrenia.
There is no prior mental illness in our family. Her main symptom is that she has gone into a “religious” mode in saying that God doesn’t love her because she has been very bad. This is all she can focus on. She believes a demon has entered her body and at one time, upon hospitalization, she believed that she was Satan. She is currently going through a divorce from a controlling husband, which is taking a toll on her mentally.
My question is this: Should we be seeking counseling from an abuse center, or continue seeking a psychotherapist? No one has agreed on a diagnosis. And if we continue seeking psychotherapy, how does one go about finding the best in the field, in our area? She has seen 4 doctors, all who disagree on a diagnosis. We are at our wits end and would like to see some progress. I do know at this time, she is on Depakote, and other drugs. Should these drugs be “helping” her, because I don’t see much improvement.
ANSWER:
You brought up the most important issue – what is the diagnosis (or what are the diagnoses). When everybody disagrees, the family and the patient are stuck in the dilemma you have. This is a situation where you need to be knowledgeable. Carry a DSM-IV with you to a psychiatrist or therapists office and ask why a diagnosis is being made, and review the criteria with the professional. It’s very reasonable to ask why the diagnosis is being made. It can be difficult finding someone you like and feel confident with. Friends and others can give recommendations, but you may have to “shop” physicians to find someone you (or your sister) feel comfortable with. Sometimes it’s worth traveling to an academic center for an opinion, like a University.