Introduction:

At my last psych appointment, my shrink decided I might be hypomanic. Why? Because I read from highly organized notes while advocating for myself, spoke quickly (because I had a lot to get through in a short time), and defended my choice to write and share my memoir publicly. Apparently, being prepared and assertive is cause for concern now.

I’ve already shared my initial email outlining my concerns about my psychiatric care here. What I haven’t shared—until now—is the response I received and my follow-up.

First, let’s go through the official list of hypomania symptoms as described on the ever-reliable Wikipedia, our modern oracle, shall we?

• Euphoria: Oh, I’m sorry—am I too happy for you? How dare I feel joy without permission.

• Inflated self-esteem: Or maybe I just finally believe in myself after years of being told not to.

• Irritability: Have you met people?

• Increased wakefulness: I’m awake, alert, and productive. The horror.

• Racing thoughts: It’s not my fault my brain runs laps while yours is still tying its shoes.

• Pressured speech: Sorry if my excitement and endless ideas are too much for your conversational monotone.

• Hyperactivity: Oh no, I’m doing too many things instead of doomscrolling in bed.

• Impulsivity: I made a spontaneous decision? Call the authorities.

• Disinhibition: I spoke my mind? Clearly a sign of illness.

• Distractibility: Or maybe your unoriginal takes just don’t hold my attention.

• Emotional lability: Sorry, are my human emotions inconvenient for you?

• Aggression: It’s only “aggression” when I stand up for myself.

Honestly, if half these symptoms weren’t pathologized, they’d just call it being “highly motivated,” “opinionated,” or “driven.” But sure, Wikipedia. Whatever you say.

It seems my willingness to advocate for myself—and challenge a system that would rather medicate me into silence—has raised alarm bells. After sending my initial email, here’s how my psychiatrist responded:

---

Re: Critical Concerns About Psychiatric Treatment and Patient Well-Being

Hello Ilana,

I’m sorry to hear that you were upset about our interaction last week. We have had a good working relationship for the past few years and I hope that it can continue.

From my perspective, you had called me and told me that your family was concerned that you were exhibiting manic symptoms. After my assessment, I agreed that there was a change in your behavior. You yourself agreed that you were in a hypomanic state. Given that you have had serious episodes that have required hospitalization, I told you that I believe that we need to intervene to return you back to your baseline.

The simplest option was to restart the Vraylar, which you had taken during the time I had followed you. You had taken this medication for several months without severe side effects. It is considered to be a first line treatment for hypomania. Given that you have tried other options, including lithium, Epival and other antipsychotics and had difficulties with many of the others, the simplest solution was to restart this medication, which I can confirm that you did tolerate during the time I was treating you. If you would prefer to try a different medication in the antipsychotic family, for example, risperidone or lurasidone, Please let me know and I’d be happy to change the prescription at the pharmacy.

You had mentioned the PTSD during our interview. We had been working together for nearly 3 years and it was the first time that you have mentioned this. I thought it was necessary to explore at least to some extent what you were referring to. After you expressed the distressing situations, I ask you if you needed therapy to try and work on it. You told me that you had had a lot of therapy and that you are now using AI, which you feel his providing the appropriate therapy that you need.

Regarding the migraines, if you have a severe migraine, that is not improving after several days, the best thing to do is to go to the emergency department. They can give you Injectable medications in the emergency department that may be more effective. Also, there’s a new family of migraine medications. That has come on the market in the past 10 years. You may not have tried it with Dr. A.

Given that I was worried about you at your appointment, we scheduled an urgent reassessment next week. If there is a change in your state or you would like to discuss your treatment with a different doctor, I strongly encourage you to go to the emergency department at the Montreal General Hospital. 

Please note that I do not normally email with patients about clinical matters. I am doing this exceptionally because I am worried about your mental state. I will not be responding to follow up emails unless it is for a specific request to try a different antipsychotic as outlined above. 

Sincerely,

Dr. Z

---

And here’s my reply—clear, direct, and backed by decades of successfully managing my mental health:

---

Subject: Response to Your Email – Clarifications and Additional Context

Thank you for your prompt response. I would like to clarify some points and provide additional context.

First, I have lived with my bipolar diagnosis for over 25 years and have actively managed my mental health with the help of several respected psychiatrists. Both Dr. F at the Allan Memorial Institute and Dr. Z, who treated me for nearly a decade, agreed that maintaining a hypomanic state was not only manageable but preferable for someone with my creative drive and cognitive intensity. Dr. W also recognised my creative genius and supported a treatment plan that preserved my creativity without excessive medication.

Aside from the significant destabilisation I experienced in 2021 due to extreme external pressures and prolonged psychological abuse, I have consistently managed my mental health without the need for heavy medication or hospitalization. My ability to navigate intense pressures while maintaining stability has been well-documented over the decades I have been in psychiatric care. Your suggestion that hypomania inherently necessitates intervention disregards the nuanced care plans that have worked for me for years.

Advocating for myself, asserting my needs, and pushing back against inadequate care are not signs of mania—they are signs of self-awareness, strength, and a commitment to my well-being.

Additionally, I brought up my CPTSD as well as my suspicion that I may also have ADHD and/or be neurodivergent during our very first appointment in September 2022, after thoroughly researching both conditions, though I have not consistently revisited these issues due to prolonged periods of depression that prevented me from advocating for myself properly. Whether or not this was documented in your notes, I know for certain that I raised these issues from the outset.

The emotional strain of unpacking my trauma during our recent session directly triggered my current migraine, which aligns with my long-standing experience of PTSD-related migraines.

I have already been to the emergency room twice in the past for severe migraine attacks, where even injectable medication provided little to no relief. I have also tried the newer migraine treatments that have come to market, including two types of injectables—Aimovig and Emgality—prescribed by my then neurologist Dr. A. R.-C, who also prescribed Fiorinal, as it remains the only effective option for pain relief for me, as confirmed by my previous doctors, starting with Dr. A.

While I have been under immense pressure, it is a state that has been deemed safe and manageable by multiple professionals familiar with my case. I am advocating for a treatment approach that respects my mental health needs, creative identity, and extensive history of managing my condition successfully.

Sincerely,

Ilana Shamir

CC: MUHC Ombudsman, Dr. F.

---

Outro:

I have a follow-up appointment on Wednesday. Whatever happens, I’m ready. I regularly speak with my stepfather, Robert—who reads my blog and often comments publicly. He knows me well, supports me unconditionally, and is more than willing to back me up.