Case Study: The Effect of Clinical Rhetoric on Patient Prognosis | Yuliya Vayner

 

i. The National Library of Medicine says patients with multiple disorders have an unfavorable illness trajectory (1)—unfavorable like a chance of rain, bad odds at a casino, like risk of suicide being 40 times that of the general population. 

ii. A sick brain plays Russian roulette with itself inside the skull: insomnia and/or hypersomnia, euphoria and/or anhedonia. Regardless, a dog who barks at the din will be labeled reactive.  

iii. An animal caught in a trap has two choices: to bite someone—biting petulance biting bitterness—or itself—biting shame (2). 

iv. Experts are not hopeful about recovery. The illness complicates the illness course. Circadian rhythm disruptions invite the hyperdopaminergic state and simultaneously present as part of it. 

v. In short, “two poles” is a misnomer (3), a gross diminisher, when both poles are on fire at once.  

vi. Experts suggest atypical antipsychotics, anticonvulsants—with both experts and patients acutely aware that the same medication that may be working now has already stopped working sometime in the near future (3). 

vii. Somewhere in a journal, someone has already estimated the number of years you have left.  

 
 

  1. Patel RS, Manikkara G, Chopra A. Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals. Medicina (Kaunas). 2019 Jan 14;55(1):13. doi: 10.3390/medicina55010013. PMID: 30646620; PMCID: PMC6358827. 

  2. Borderline Personality Disorder (BPD). Cleveland Clinic, 2025 July 25.

  3. Andriakos J. This is What a Mixed Bipolar Episode Feels Like. Self Magazine, 2018 December 7

  4. Muneer A. Mixed States in Bipolar Disorder: Etiology, Pathogenesis and Treatment. Chonnam Med J. 2017 Jan;53(1):1-13. doi: 10.4068/cmj.2017.53.1.1. Epub 2017 Jan 25. PMID: 28184334; PMCID: PMC5299125.

Yuliya Vayner, who graduated Hunter College with a BA in writing, works in children's publishing. Vayner's work has appeared in Central Dissent, Common Ground Review, Scapegoat Review, Mojo, Healing Muse and Esthetic Apostle. She lives in Brooklyn with her cat.

PRINT