it possible that there is not a psychiatric disorder at all?Gersabeck (2001) suggests that mental health professionals embrace a new diagnosis, substance (chemical) dependency-induced psychosis (SDIP). He states that the “majority of persons with a SDIP quite probably wouldn’t have become psychotic had they not first become chemically dependent” (2001, p. 2). According to Gersabeck’s recent research, a good clue to the SDIP diagnosis often is the chronic mentally ill person who stops his/her medication and starts to use alcohol or another addictive-type drug. The person may also combine the drug and his/her medication. Often, the result of the former action is rehospitalization and a psychotic episode.As I reflect on the past few months that I have interned on 2P at the VAMC, there have been numerous patients admitted with a diagnosis of depression, bipolar, schizoaffective, or schizotypal disorder with or without suicide ideation, and no reference to substance abuse. When I complete the social history on these patients, they also have extensive substance abuse issues that were not addressed by the admitting physician. For example, John, a tall gaunt and very pasty 38-year-old veteran was admitted and diagnosed with a mood disorder – severe bipolar I, in the manic stage (having an abnormally and persistently elevated expansive or irritable mood lasting at least one week). The veteran had a long history of depression and suicide ideation. John was drugged and slept for two days before I met with him. During the course of our two-hour interview, I ascertained that he had been on an 8-month methamphetamine run and just prior to being hospitalized, John had not slept for nearly four days. He had been using “uppers” since early adolescence, four years before his first diagnosis of depression. Did his substance abuse cause his mental illness? Did his mental illness cause his substance abuse? Which sh...
