…I’m returning to do the test suggested by my therapist in our previous meeting – the Beck Depression Inventory II. Tremendous. Doing a test sounds like something you see in those silly magazines that tell you how good a lover you are are some such other rubbish, but apparently this test is rather serious.
So I return that afternoon and Dr Black administers the Beck questionnaire. She explains it is the Beck Depression Inventory II, a paper-and-pencil multiple-choice test devised by the 20th century renowned cognitive-behavioural psychiatrist, Aaron T.Beck. What on earth does she mean ‘administer’? American and British English are certainly different: one neither better or worse than the other, but certainly there are a lot of variances. She hands me a questionnaire and instructs me to quickly glance it over, but that she will be asking me the questions on the test and adding others tailored specifically to discern her hunch about
me being bipolar. I begin answering questions, ones I’m sure I’ve answered before at some point. This approach encourages a sense that she is really listening to me and this is not a tick box exercise.
“I find that to give the multiple choice test to the patient to do on their own leaves much room for error – not catching the full range of the patient’s symptoms. There is a tendency to not answer with full honesty on these multiple-choice tests. People have a natural inclination to want to impress their therapist, so try to present themselves in the best light, or not, in a worst light. In either case, it is an exaggeration of the truth or lack thereof.
It s always best to tailor the queries to the individual – keeping true to the basic questions. I leave no stone unturned. I ask Stuart many detailed questions about his symptoms and when they first started to appear and what might have been the precipitants. I ask about seminal events in his life that have left an imprint on him – positive or negative.”
The test seems to focus on depression. However, Dr. Black adds queries about my mood shifts. Do I feel up and down? Do I go all around? Can I feel euphoric, angry, depressed or hypomanic over short periods of time? Have I ever had intrusive thoughts of wanting to throw myself in front of an oncoming train, or have I had fantasies of suddenly losing myself to impulse and pushing someone else in front of a train? Have I ever pressed myself against the metro station platform wall or sat on my hands, trying to create a reassuring sense that I will not lose myself in the moment of total folly’s loss of impulse control?
They are uncomfortable questions because, in truth, they resonate strongly. It’s less a wish to hurt others, but more a desire to just stopping the noise and ending life’s torturous, twister mental, sinuous journey. I’ll jump in front of the train rather than push someone else. I suspect there is an aspect of theatrics of my character to think this. The ego demanding that the world know just how bad it all was for me.
I remember reading about Winston Churchill’s more sombre moments. This twentieth century Colossus, this son of an American mother, a man who led Britain to victory during the Second World War suffered from what he called the ‘black dog’. He spent days in bed with depression. He spoke of removing himself from the edges of platforms for fear that a second action would end everything. Very few days have passed recently where I haven’t had the ‘black dog’. Sometimes I just experience fleeting thoughts of suicide that I easily bat away, but others persist and develop ominously. It’s what many Bipolars experience I suspect when they have their ‘black dog’. Is this me?
“A common misunderstanding surrounding bipolar is that there must be the presence of wild mood changes sweeping across the vast spectrum of affective states. One MUST be ‘hypomanic’ (just short of full blown mania) with states of exuberance and swelling feelings of omnipotence and grandeur for there to be a diagnosis of bipolar. Not so. The ‘black dog’ Stuart refers to is certainly the predominant experience of folks with Bipolar Type II – the rapid switching kind of mood shifting hell – but it will be interspersed with alternating cycles of, yes, exuberant, ‘hypomanic’ states, and / or a sense of feeling numb, indifferent, and/or stretches of agitation and irritability to all degrees, a state which is known as ‘dysphoric hypomania’ – no happiness therein, but a vibrant, restless energy nonetheless. It is believed that Sir Winston Churchill suffered from bipolar. I certainly think he did.”