I came across an incredible blog post over the weekend about a young man with a dual diagnosis.
I’ve never read this blog before, but the post in question is a mother’s interview with her teenage son (I’m assuming that ‘he’s a teenager; his age is never given, but one of the tags is “teenager” and the Twitter tweet that led me to the article said he’s a teenager) who has Asperger’s syndrome, bi-polar disorder and obsessive-compulsive disorder. This is called a dual diagnosis – developmental disability and mental health diagnosis. It’s a fascinating read, and a couple of things about it really struck me.
1) R’s Level of Insight into His Dual Diagnosis and His Disabilities
When I worked with teens with intellectual disabilities who could understand that they had a disability, we had a lot of conversations about what “disability” was. Some of them didn’t realize that they had one. Some knew that they had one, but simply didn’t consider themselves people with a disability. Some didn’t want to be considered one of “those people” out of fear of being teased, or of being associated with groups of people with whom they felt they had nothing in common.
I tried to get the message across that if you understand what your disability is and how it affects you, you know how to ask for what you need – from doctors, from formal supports, from informal supports, even from potential employers. I struggled with depression and obsessive compulsive disorder in high school and through my twenties, and I know that I could not have explained nearly as clearly as R how these things affected me.
R’s family needs to look at this ability to reflect on his dual diagnosis and to explain what it’s like to be “in his mind” as a strength that he can utilize.
2) Which Disability R Perceives As Giving Him The Most Difficulty
Some of the difficulties that R experiences likely come from his Asperger’s diagnosis. The trouble picking up on social cues and the social awkwardness are symptoms of Asperger’s (they can be symptoms of other things, too, but if he’s been diagnosed with Asperger’s, those things likely are likely part of that disorder for him.) The fixation on video games and technology may also be a part of his Asperger’s, even though he seems to identify it as something separate.
Based on this interview, it seems to be the bipolar part of R’s dual diagnosis that causes him the most distress. It makes me think about the controversy over the proposed changes to the diagnostic criteria for autism for the DSM-V, and wonder:
- How many of the R’s medications are treating Asperger’s-realated issues?
- Are the new psychiatrist and psychologist he’ll be seeing supporting him for the bipolar? The Asperger’s? Both?
- What are his doctors’ take on the video games as an addiction (as opposed to another manifestation of Asperger’s)?
3) A Downside to Canadian Medicare
I’ve never said that there weren’t any.
In emergency situations, Canadian Medicare has always served me well, as I’ve blogged on before. But when I read that R will be seeing a psychiatrist…I thought, “Wow, just like that?”
In Ontario, it’s very difficult to see a psychiatrist or a psychologist anymore if it’s not an emergency situation. It wasn’t always like that. But it is now. It’s very frustrating when you’re supporting individuals who need a psychiatrist and it’s so difficult to get them access to one.
I realize that for people without insurance in the United States, this sort of treatment is very expensive. But with non-emergency psychiatric care so hard to come by in Ontario…it does make me wish sometimes that it was as easy as being able to find a psychiatrist and pay for services, just like that.
I guess there are no easy answers when it comes to health care.
Thank You, Ashtyn Evans and R
Ashtyn printed all of R’s responses about his dual diagnosis unedited in her blog post, and plans to blog about her feelings later.
I’m looking forward to reading her thoughts about R’s dual diagnosis.