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HIPAA protects patients, but has no mechanism for illnesses that prevent self-recognition.

Families often have crucial insight into a patient’s condition, but the system rarely listens to them.

Patient autonomy and protection should be balanced, especially when patients can’t see their illness.

Before the manic psychosis I described in earlier posts, I lived a long stretch of polypharmacy and misdiagnosis. It began with a suicidal collapse in 2016, an overdose that left me in a coma for six days. What followed were years of antidepressants and other medications prescribed for what clinicians called major depressive disorder and generalized anxiety disorder.

The diagnoses were wrong. The depression was real, but it was the depressive pole of a bipolar illness no one had yet recognized, and the antidepressants prescribed to treat it were the very class of drugs known to destabilize a bipolar brain. Each prescription, written in good faith for the symptom in front of the clinician, quietly poured fuel on a fire none of them could see.

The correct name finally arrived in March 2020, as the world emptied itself for the pandemic. I was involuntarily committed to St. Mary's Hospital in Madison. The behavior I had been experiencing as righteousness had crossed the line into something the law was finally willing to name. A psychiatrist I had never met before—impatient, rushed, with the bearing of a man already late for his next room—diagnosed me for the first time correctly with bipolar I disorder.

What he did not do was nearly everything else. He did not mention anosognosia, the condition that would determine whether I could absorb the diagnosis he had just delivered. He did not ask whether a family member could be brought into the conversation, something the Health Insurance Portability and Accountability Act (HIPAA) permits with patient consent and that good psychiatric practice would have recommended. He did not schedule a family meeting to help the people closest to me understand what bipolar I disorder is, how it presents, what the medications do, what relapse looks like. Instead, he wrote prescriptions and discharged me. It was the same thing that had been done to me, in various forms, for the previous eight years: pills thrown at a problem no one had taken the time to see whole.

It was the diagnosis I had needed for years.

But it was spoken to the wrong person, in the wrong way, in a room emptied of everyone who could have helped me........

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