Future career issues if diagnosed with depression?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by John382, Nov 12, 2017.

  1. John382

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    I've tried searching for active threads with no luck. Im currently in my first semester of my PsyD clinical program. Unfortunately I have been hit with what appears to be depression. I am not suicidal in any way but have have some classic symptoms such as low interest, low energy, and concentration issues. Im thinking of reaching out to speak to some one and rule out other causes. But im afraid a diagnosis and especially treatment such as antidepressants will damage future licensing and employment opportunities. I don't know wether the California licensing board will even care or ask. According to online info they do monitor the pharmacy prescriptions. As far as employment I would like to work for the California Correctional Health Care Services as pyshcologist and I don't know if government and state agencies like them would disqualify me I know military would be out the window.
     
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  3. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    Substance abuse treatment can present a barrier in some states. Other than that, no, so long as their is not evidence that your judgement is compromised do to said disorder.

    And the military is full of individuals with messy psych histories (I used to work in the VA), so in and of itself its not a disqualifier.
     
  4. G Costanza

    G Costanza Psychologist - Private Practice
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    FWIW- Most people don’t get through a doc program in psych without a diagnosable mental health condition at some point.
     
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  5. foreverbull

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    How would this be legal and not a massive breach of confidentiality? Where are you hearing this?

    I am licensed in CA and I wasn't asked invasive questions about mental health history/meds. Your mental health records are sealed from most places, even in most employment background checks. I wouldn't worry about it.
     
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  6. G Costanza

    G Costanza Psychologist - Private Practice
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    If you plan to work for a gov position requiring higher level clearance, than you will have to sign a release allowing investigators to ask your therapist/doctors if they have concerns about you. And what you have described in the thread this far would not be enough for me to have any concerns.

    Sorry you’re having a hard time but glad you’re thinking about getting support.
     
    #5 G Costanza, Nov 12, 2017
    Last edited: Nov 12, 2017
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  7. FreudianSlipper

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    history of mood disorders are disqualifying for military internship/psychologist positions. For nearly anything else, that should definitely not be a concern at all. State corrections and forensics don't dig that deep in my state, and they definitely shouldn't. Nearly my entire doc program is in treatment of some kind, a good chunk of which are exacerbated by grad school. Get the help you need. Life happens.
     
  8. MCParent

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    The web site probably meant state bar associations, or the OP has law school friends. The state bars ask about mental health dx and tx.
     
  9. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Really? Most?
     
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  10. G Costanza

    G Costanza Psychologist - Private Practice
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    I’ve never read a study about it (might be an interesting dissertation topic), but yes. More often than not, my friends in the field and in grad school suffered from something. Mostly anx and dep related concerns. You didn’t know a lot of people who qualified for an adjustment disorder either when beginning grad school, a new prac, or their dissertation?
     
  11. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I would say no, a majority of my program did not generally have a diagnosable mental health condition. A few here and there, yes, but nowhere near most.
     
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  12. singasongofjoy

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    Pretty common and not a problem other than military psych I guess. Half my lab took meds and/or went to therapy at some point during my program. Fair chance that's higher than most as since internship I've surmised I might have been a little more stressful/dysfunctional st the time than most. But still - v common, don't sweat it, take care of yourself without worried about future career implications. Would be more harmful to your career to do nothing and have it get worse.
     
  13. Meteora

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    Others have addressed the important points already.

    I just want to add that even if it were to affect your career in some way, would it change your decision to seek treatment? I would hope that you would want to be at your best, both physically and psychologically, to be as effective in working with your clients as you can. I would argue that self-care is an essential aspect to the job of psychologists and mental health practitioners.
     
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  14. Justanothergrad

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    Not sure about what portion get diagnosed (potentially for all sorts of logistical concerns, like money.. making the proposed tax changes even more ridiculous since money is one of the primary barriers to MH care.. but thats an aside), but the portion of graduate students who meet criteria for some type of depressive disorder at some point in their training is excessively large. I believe the last statistic I saw was like 70% and it was a fairly comprehensive study.

    Disclaimer : those statistics are entirely from memory, but it was substantial.
     
  15. WisNeuro

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    I'm sure it's slightly elevated at least. I just think some have an issue of over pathologizing normal stress in certain professions.
     
  16. MamaPhD

    MamaPhD Psychologist, Academic Medical Center
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    This might be a good example of that area of overlap between "overpathologizing" and "meets criteria for DSM-5 disorder." Though I was legit depressed one year in grad school and I've known quite a few others with similar experiences.
     
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  17. Justanothergrad

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    Perhaps, but it seems like graduate training offers the perfect nexus for mental health issue vulnerability (high stress, low financial resources, new environment with potential for less social support, typical trainee personality and demographic characteristics, etc.) so I'm more tempted to buy the statistics, or at least that graduate training results in higher rates of anxiety and depression.
     
  18. PSYDR

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    Most programs used to require personal psychotherapy or psychoanalysis as part of the doctoral education. It became a problem with the IDEA, and other healthcare laws. So it went the way of the buffalo.

    That’s the context in which you’re asking about how this stuff affects your career.
     
  19. G Costanza

    G Costanza Psychologist - Private Practice
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    Perhaps I misspoke. I should have said more often than not rather than “most.” Regardless, my point to the OP is that their experience is shared by many others.
     
  20. psych.meout

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    As far as military psych goes, depending on the diagnosis, you could get disqualified from accessions to the officer development program, but active-duty psychologists are in such high demand that you could feasibly get a waiver. Again, it depends on the particulars of your diagnosis, treatment, etc., but the door to military service isn't necessarily closed simply because you were depressed and were diagnosed and treated.
     
  21. WisNeuro

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    Fair, and I'm all about reducing stigma and getting help when needed. I also think that there is a tendency to overpathologize normal stress given high stress situations as pathological. We can reduce stigma without simply introducing another stigma.
     
  22. WisNeuro

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    Come on now, if you're going to troll this forum, you can do better than this.
     
  23. psychrat

    psychrat licensed psychologist
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    This--- that does not seem legal.
     
  24. futureapppsy2

    futureapppsy2 Assistant professor
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    It is. Most licensing boards ask about mental health, substance use, and other medical history under the umbrella of "public (e.g., patient/client protection)."
     
  25. WisNeuro

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    Yeah, it's a similar reason that police officers can be screened for potential psychological issues. If your mental health can directly impact the safety of the public through your profession, it's fair game.
     
  26. psych.meout

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    Interesting? How exactly does this process work? Is any history of mental health Dx or Tx disqualifying or just certain kinds (e.g., involuntary hospitalizations or schizophrenia) or is there a certain timeframe (e.g., Tx or Dx within the past 5 years) or is it more about having uncontrolled and untreated issues (i.e., highly symptomatic and not being under professional care)?

    I can see how it's reasonable to deny licensure for someone who is wildly unstable and untreated, but how does this not violate the ADA if their Dx was remote and not that severe (e.g., anxiety/mood/bipolar Dx 5+ years prior), they are not currently symptomatic, and they concurrently receive professional care?
     
  27. smalltownpsych

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    I think this is really the intent of those types of inquiries. All of the states that I have been licensed in or looked into licensure have questions about mental health treatment. It is up to the board to decide whether it is sufficient to stop someone from obtaining a license. If they do deny, then the individual has recourse to sue them so they are typically reasonable in how they go about it.
     
  28. psych.meout

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    That's what I was thinking as well. The military is pretty strict about Hx, Dx, and Tx, but even their standards have some nuance to them.
     
  29. smalltownpsych

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    Yup. Big difference between "I was involuntarily hospitalized last week for the 5th time and am notoriously non-compliant with treatment" vs "I took an ssri and saw a psychologist for therapy when I was depressed in undergrad."
     
  30. foreverbull

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    My understanding is that it depends on the state board.
    CA only asks a few questions to determine "fitness for practice"(unless you have convictions/legal issues/disciplinary issues):

    See page 3: http://www.psychology.ca.gov/forms_pubs/application.pdf

    Are other states asking more involved questions about history than this?
     
  31. WisNeuro

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    CA asks

    "Are you currently affected by any physical or mental condition that in any way impairs or limits your ability to practice psychology with safety to the public? If yes, explain on a separate sheet of paper. "

    It's fairly broad, but legally, it could include diagnoses such as depression, bipolar, etc. Essentially, the licensing board needs to make sure the liability is off them in case you do something to damage a patient or get a case brought against you. This way the board can say that they asked, and if you did not disclose, you are the one guilty of perjury/fraud and they are not liable for it.
     
  32. WisNeuro

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    Here's one from another state that I've lived/worked in

    "1. Do you have a medical condition which in any way impairs or limits your ability to practice your
    profession with reasonable skill and safety? If yes, please attach explanation........................................  
    “Medical Condition” includes physiological, mental or psychological conditions or
    disorders, such as, but not limited to orthopedic, visual, speech, and hearing impairments,
    cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes,
    intelelctual disabilities, emotional or mental illness, specific learning disabilities, HIV disease,
    tuberculosis, drug addiction, and alcoholism.

    If you answered yes to question 1, explain:
    1a. How your treatment has reduced or eliminated the limitations caused by your medical condition.
    1b. How your field of practice, the setting or manner of practice has reduced or eliminated the

    limitations caused by your medical condition.

    Note: If you answered “yes” to question 1, the licensing authority will assess the nature,
    severity, and the duration of the risks associated with the ongoing medical condition
    and the ongoing treatment to determine whether your license should be restricted,
    conditions imposed, or no license issued.
    The licensing authority may require you to undergo one or more mental, physical or
    psychological examination(s). This would be at your own expense. By submitting this
    application, you give consent to such an examination(s). You also agree the
    examination report(s) may be provided to the licensing authority. You waive all claims
    based on confidentiality or privileged communication. If you do not submit to a
    required examination(s) or provide the report(s) to the licensing authority, your
    application may be denied.
     
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  33. psych.meout

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    The wording seems a bit odd and ambiguous.

    Does it mean that you need to disclose any mental health Dx for which you currently receive treatment (e.g., anti-depressants for MDD, anticonvulsants or antipsychotics for bipolar I/II), because it could potentially impair or limit you OR do you only have to disclose your history and current treatment if it is currently impairing or limiting you in any way?
     
  34. foreverbull

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    Yes, this is true, although I was operating under the assumption that most folks would say no and move on if they have a history of mental health treatment, but not current impairment.

    If the OP is currently struggling with mild depression symptoms, is that necessarily limiting/impairing practice ability, though? Especially if the OP ends up controlling the sxs with an SSRI or therapy, which may alleviate the symptoms and not be a "current" issue by the time the OP applies for licensure. I suppose that's a subjective judgment call on the part of the applicant in terms of checking "yes" or "no".....as well as how one chooses to define "currently" (Past month? Past year? Past 6 months? Past 2 years?).

    Wow, that is far more detailed! Again, though....can an applicant protect their own treatment history if they are not currently impaired and it doesn't limit them in terms of professional practice? There still seems to be a bit of room for ambiguity.
     
  35. psych.meout

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    Even the more detailed version still seems ambiguous about this. The phrasing is largely similar in the present tense of whether it "impairs or limits your ability to practice your
    profession with reasonable skill and safety." Someone could easily and honestly construe this about the present moment and not how they were several years ago when they were first diagnosed or how they might be in some future where they discontinued treatment or suffered some other stressor that would strain their current high functioning.

    Edit: From personal experience, patients often misconstrue these kinds of questions even when they are very explicit, e.g., "Have you ever...."
     
    #34 psych.meout, Mar 13, 2018
    Last edited: Mar 13, 2018
  36. smalltownpsych

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    Here is the wording from current state's application:
    Have you been diagnosed in the past 5 years with a physical condition or mental health disorder involving potential health risk to the public? If yes, please provide a detailed explanation.
    This one does set a time limit, but is very vague with "potential health risk to the public". If I had personally been treated for depression, I would probably not see that as a "potential health risk to the public". They also ask if you have ever been treated for chemical dependency or convicted of any crime ever.

    The prior state I was licensed in did not ask about mental health treatment at all, only asked if you were currently addicted to substances that could impair you, and only asks if you have been convicted of a felony. Definitely a wide variation between how these boards ask these types of questions about your background.

     
  37. WisNeuro

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    You can disclose or not disclose whatever you want. If you get an action brought up against you at some point, though, expect that any omission may be used against you if uncovered.
     
  38. psychrat

    psychrat licensed psychologist
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    I think it is also important to remember that untreated depression (or any other mental health concern) is more likely to negatively impact your clinical practice with patients than treated (or currently in treatment) depression.
     
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  39. smalltownpsych

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    It seems that there is an assumption is that anyone who has been diagnosed or treated for depression poses a potential health risk. When I am treating patients myself, much of the time I would not think that mild to moderate depression typically would impair function sufficient to where they would pose a risk to others in their job setting. I have worked with people who operate heavy machinery, work in healthcare, and law enforcement.
     
  40. WisNeuro

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    The concern is that it potentially could affect patient safety. For example, working with high risk (DBT with suicidal behaviors).
     
  41. futureapppsy2

    futureapppsy2 Assistant professor
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    I think that argument is somewhat complicated by the NYT article about Linehan from a few years ago where she "comes out" as having had severe mental illness (probably BPD), an extremely lengthy psychiatric hospitalization, and multiple suicide attempts.
     
  42. Meteora

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  43. temppsych123

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    Chiming in as someone who is now officially "Dr" and who got lots of treatment for depression during graduate school:

    GET. THE. HELP. YOU. NEED.

    Depression is treatable (not to imply "curable" in all cases, but often "manageable" like other chronic illnesses). Don't prolong your suffering now because of possible paperwork issues later on. Who knows what state you might want to get licensed in some day, how their rules might change between then and now, etc. I used to be extremely fearful of even talking about my issues with my graduate mentor or, heaven forbid, anyone else in my program, but ultimately found out that plenty of people you might never expect have had their own periods of difficulty where they sought help, and they can be allies for you.

    If you're particularly concerned about the privacy of your medical records, you can find a provider who takes self-pay, meaning that the paperwork doesn't go through an insurance company. That means that, at some future date, someone attempting to access your medical history would have a harder time doing so (what are they going to do, call every person in private practice in every city you've ever lived in to see if someone is willing to break confidentiality to say you were a client way back when?). I also think that, from an ethics perspective, it is far more ethically appropriate to get the help you need now, for your sake and for the sake of your eventual patients, than to continue to suffer so that you can check the right box on a form. I would argue that identifying your own needs, attending to your well-being, and getting the support you need are actually signs of insight and appropriate ethical behavior, compared to someone who is clearly struggling but refusing to acknowledge it or get help (with a potentially detrimental effect on patients).

    RE: Working with high-risk clients - I think the important issue is whether your issues are impacting your ability to perform the types of work you are otherwise trained and competent to do, whatever that work is. For example, I would much rather have an adherent, comprehensively-trained DBT therapist who is practicing as part of an adherent DBT group (including skills trainers, individual therapists, consultation team, the whole thing) who is dealing with an emotional issue outside of work with appropriate treatment and consultation with their team, than get "DBT-lite" from someone who watched a Marsha Linehan speech once and now thinks they're competent to treat highly suicidal people, whether or not they've got their own issues to deal with.

    Just my (perhaps more than) 2c.
     
  44. WisNeuro

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    Complicated, yes. But not everyone functions the same at similar levels of symptomatology. Anyone who has treated individuals in mental health can attest to that. The key word is potential, note that it doesn't say "probable", or "highly likely to."
     
  45. Harry3990

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    This is an interesting issue.

    Given all the discussion so far, I’m curious whether people would lean towards reporting mild/moderate depression or adjustment/anxiety issues and prior treatment when posed with this phrasing of “potential” harm to clients. Or omit such Dx or prior tx because of taking the stance that the risk is so minimal when simply adhering to best practices.

    I feel like I’m on the fence.


    Sent from my iPhone using SDN mobile
     
  46. smalltownpsych

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    Exactly my perspective or question. In the past I might have thought it would make sense to not disclose, but in consultation with an attorney about another type of questionable wording with a licensing application, he suggested being more open rather than less and if the licensing board was unreasonable then we would just sue them. I imagine it would be hard to get a jury to side with a licensing board preventing you from working based solely on the fact that you had been depressed and treated for it when you had also satisfied all of the rigorous demands of our education and training. So I would probably lean toward over-disclosure as opposed to under-disclosure at this point.
     
  47. WisNeuro

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    I'd disclose it, but I'm fairly conservative on the CYA side of things.
     
  48. WisNeuro

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    The way I see it, in the unlikely, but wholly possible, instance of a board action being brought against you, I wouldn't want anything in my licensure application to be discrepant from anything that is potentially discoverable. Opposing attorneys will seize on those opportunities and make your life a living hell.
     
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  49. temppsych123

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    This is a fascinating discussion, because I consider myself very risk-averse, but I have a different gut reaction. We know that bias and stigma are real, for any kind of disclosed disability or health condition, but particularly mental health diagnoses, even among trained individuals who "should know better." The board has little to lose by denying you a license (other than the possibility of a lawsuit, which many people won't have the resources/time to pursue), whereas the applicant has a huge amount to lose if they can't get licensed. Of course, there is the non-zero risk that you eventually get sued, and if it did come out that you didn't include such information on the application, that would be a huge issue. But there's also the question of how likely is it that something like "mild/moderate depression or adjustment/anxiety issues and prior treatment" (per Harry3990) would actually be discoverable by the board, opposing counsel, etc. It would take a fairly major malpractice suit to get a judge to order the release of a psychologist's personal medical records (say from past insurance providers), and even in that case, mental health treatment in the US is so fragmented that lots of care isn't tracked in a centralized way.

    Of course, if someone gets licensed and then does actually behave unethically as a result of untreated/unmanaged mental health issues, and this impacts a client, then the odds that the psychologist's mental health history and records will be investigated goes up quite a bit! But I think we'd agree that, if you were actually practicing in a way that was impairing patient care due to illness, that would be something that should actually be caught by regulatory boards, as that's part of their job.

    Anyway, I'm certainly not arguing that people should just lie on their licensure applications, just that there are real costs and risks associated with each option, of varying probabilities, to consider. And regardless, I'll still stand by my assertion that it's better to get the help you need now and to actually succeed in your graduate training to become a psychologist, than to continue to suffer (which could very well have a much more serious impact on your ability to ultimately practice, insofar as depression impacts learning, academic performance, work performance, etc). If necessary, years down the road when you are applying for licensure, you can consult a lawyer in your state familiar with professional licensure regulations in that jurisdiction prior to submitting your application.
     
  50. G Costanza

    G Costanza Psychologist - Private Practice
    5+ Year Member

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    What about the folks who seek treatment and have a formal diagnosis of depression on record but are never informed by the provider?
    Putting the applicant in the position to determine their potential for risk seems like a reasonable starting point and also fraught with problems.
     
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  51. temppsych123

    2+ Year Member

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    GREAT point that I totally had not considered. Waaaaay back when, I requested records from a therapist (well, a psychiatrist who did therapy...not my choice, but whatever) I saw as a teenager. The notes were a ****show, but included mention of a bipolar diagnosis, which is totally inconsistent with the symptoms I had at the time, and inconsistent with everything I have learned about bipolar disorder since (which is quite a lot). Without requesting the records, I would have had no way of knowing that diagnosis was floating around out there, and I've never bothered to go through the process to try to amend the records, because it seems daunting and irrelevant (I don't even know what insurance provider my family had at the time, the records are way past the 7 years one has to keep them, the psychiatrist is probably retired by now, etc.). Now, I don't foresee that old record causing problems for me in the future, but who knows what wacky stuff is in some folks' medical records without their knowledge...
     

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